Comparison of surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy: Retrospective cohort study

Aim: We aimed to compare the surgical outcomes between manual free vaginal morcellation and no vaginal morcellation for uterine extraction during total laparoscopic hysterectomy (TLH) performed in a tertiary center. Materials and Methods: A total of 397 TLH either with or without oophorectomy, for a benign indication, surgeries performed at our tertiary hospital between March 2022 and May 2024 were analyzed in our study. Patients who underwent manual free vaginal morcellation were defined as Group I (n=85, 21.4%) and patients who did not undergo vaginal morcellation were defined as Group II (n=312, 78.6%). Demographic characteristics, laboratory values, operation characteristics and histopathological reports were accessed from the hospital database. Results: The median uterine weight of the morcellation group was greater. Median morcellation time was 9 minutes. While the median operation time of Group I was 80 minutes, it was 70 minutes for Group II. The groups were similar with regard to postoperative urinary tract, intraoperative urinary tract and intraoperative bowel injuries. Intraoperative vaginal or perineal laceration was detected at a greater rate in the morcellation group. Conclusion: For large uteruses, TLH is still the best option for suitable patients when performed by experienced surgeons. It has been revealed that manual free vaginal morcellation, performed without the need for additional incisions, is safe, low-cost and practical in total laparoscopic hysterectomies with benign indications.