Background: With more laparoscopic hysterectomies being performed for increasingly large uteri, prediction of surgical outcomes is becoming more important. There is a paucity of information regarding preoperative predictors of surgical outcomes in the large uterus that could be helpful in perioperative planning. Objective: The aim of this research was to examine the predictive value of ultrasonographically-measured uterine mass on surgical outcomes in total laparoscopic hysterectomy (TLH). Materials and Methods: This was a retrospective exploratory study analyzing surgical outcomes following TLH over a 15-year period. Subjects were recruited in four San Francisco area hospitals. For 1004 patients, data were collected regarding demographics, ultrasonographically measured uterine volumes, and surgical outcomes (operative time, estimated blood loss [EBL], length of hospital stay, and postoperative uterine mass). Uterine mass was calculated using the prolate ellipsoid formula and a volume-to-mass conversion formula. Results: The median patient age was 48 (range 15–90), the median body mass index was 26.0 (range: 16.3–70.5), and the median parity 1 (range: 0–9). As ultrasound-predicted uterine mass increased, both median operative time (97–141 minutes; p<0.05), and median EBL (50–150 mL; p<0.05) increased. Incidence of blood transfusion increased by 140% (1.5%–3.6%; p<0.05). Median length of hospital stay was 1 (range: 0–13) and similar among all groups. The Spearman correlation between ultrasonographically measured uterine volume and actual uterine mass was 0.867 (p<0.05). Conclusions: Increasing ultrasonographically-measured uterine mass correlated with postoperative uterine mass and predicted increasing operative times and EBL for patients undergoing TLH. Length of hospital stay was unaffected. These data suggest that preoperative ultrasound measurements are beneficial for surgical planning of TLH. (J GYNECOL SURG 31:128)
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