Removal of a Huge Uterine Mass, Weighing 11000 Grams, In an Elderly Woman with a Minimally Invasive Surgical Approach: Feasibility and Safety

Since 1993, when the first Total Laparoscopic Hysterectomy (TLH) was described, surgical treatment for uterine fibroids has changed significantly. Initially, surgeons discussed the feasibility and safety of TLH compared with vaginal and laparotomy approaches. Presently, surgeons are working to better understand the limits of TLH, especially relative to its complexity, when associated with particular clinical conditions, such as presence of adnexal masses, adhesions, endometriosis, and in terms of the size of the uterus to be removed. In recent years, we have been attempting to demonstrate that expert teams can successfully perform TLH of large-sized uteri that were once removed only by laparotomy [1,2]. In 2016, in a large series of large uteri removed laparoscopically, we reported a maximum uterine weight of 4000 g [3]. Subsequently, we described the possibility of laparoscopically removing a uterus weighing 5320 g with the support of a uterine manipulator [4] as well as a uterus weighing 5720 g without the aid of a uterine manipulator [5], both with no complications. Thus far, the weight limit of a uterus that can be removed laparoscopically and the possible complications of such a surgery remain unclear. Here, we describe an 80-year-old patient who underwent laparoscopic removal of a huge uterine mass with cystic degeneration weighing 11000 g.