Background: Hysterectomy is the second most common surgery among women, with ∼600,000 performed each year in the United States. Objective: The aim of this research was to identify preoperative factors associated with the ability to remove an intact uterine specimen transvaginally and avoid morcellation during laparoscopic hysterectomy. Materials and Methods: Patients were identified who underwent robotic-assisted total laparoscopic hysterectomy from January 9, 2008, to November 15, 2012. Charts were reviewed retrospectively for demographics. Preoperative uterine dimensions were used to calculate uterine volume. Subjects without preoperative uterine dimensions based on imaging were excluded. Demographics, indication for hysterectomy, need for uterine morcellation, histology, and actual uterine weight were noted. Statistical analysis was performed, using recursive partitioning and logistical regression analyses. Results: Four hundred and thirty-six patients were identified, with 136 excluded because of lack of data on preoperative uterine dimensions and 2 excluded because of conversions to open procedures prior to completion of the hysterectomies. Of the 298 evaluated patients, 59% underwent hysterectomy for benign indications. Morcellation was required in 62 (20.8%) of the specimens. Univariate logistical regression analysis showed that a preoperative uterine volume ≥222 mL was the most important predictor of morcellation (odds ratio [OR]: 40.43; 95% confidence interval [CI]: 18.81–86.88; p<0.0001). Multivariate analysis showed that a uterine volume ≥222 mL was predictive of morcellation (OR: 39; 95% CI: 16.17–94.03; p<0.0001). Parity was associated with decreased risk of morcellation (OR: 0.34; 95% CI: 0.14–0.83, p=0.018). Postmenopausal status was also associated with a decreased risk of morcellation (OR: 0.29; 95% CI: 0.12–0.70; p=0.006). Conclusions: Uterine volume ≥222 mL and nulliparity were the most important preoperatively determined factors predicting the need for morcellation during total laparoscopic hysterectomy. Preoperative determination of the likelihood of removing an intact uterus vaginally is important for patient counseling and operative planning. (J GYNECOL SURG 32:6)
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