Short summary

The aim of the study is to compare contained manual via a mini laparotomy or power morcellation of big uteri > 300 g or otherwise challenging for vaginal extraction in relation to postoperative pain on an numerical pain score (NRS). Primary outcome is NRS at 4, 8 and 12 hours, one week and 1 month post-operatively.

Rationale

Minimally invasive approaches are recommended whenever possible for hysterectomy. If the uterus is too large to extract through the vagina, another extraction route is required. There are different ways to approach this. FDA issued a safety communication in 2014 concerning spread of malignancy via non-contained power morcellation. FDA estimated that 1/350 women undergoing hysterectomy or myomectomy will have unsuspected malignancy. This communication led to a decrease in minimally invasive hysterectomies and major surgical complications increased.

Description of the cohort

The study is a two-center randomized controlled trial, at OUH Denmark and Karolinska, Sweden. Women 18- 50 years old, with uteri > 300 g, will be included at block randomization to either laparoscopic hysterectomy with in-bag power morcellation or manual suprapubic in-bag morcellation via a mini laparotomy.

Data and biological material

Data will be collected via electronic patient journal and electronic questionnaires, inkl. SF36 before and after the operation. The pain score the day after the operation will be recorded manually on paper and typed into the database.

Collaborating researchers and departments

Gynekologi och Reproduktionsmedicin Karolinska Universitetssjukhuset

• Kiriaki Papaikonomou, MD, PhD Senior Consultant, ObGyn
• Sebastian Brusell Gidlöf, MD PhD, Verksamhetschef Gynekologi och Reproduktionsmedicin Karolinska Universitetssjukhuset