Laparoscopy with transverse-abdominal extra-fascial hysterectomy for early-stage endometrial carcinoma, obesity, and large uterus: A case report

RATIONALE: Removal of a large uterus poses a challenge in minimally invasive surgery for patients with early-stage endometrial cancer. This manuscript presents 3 cases performed the improved surgical procedure with minimal trauma. PATIENT CONCERNS: Three patients with obesity (Body Mass Index: 31.93, 30.06, and 51.82 kg/m(2)) and large uterus (7.3 × 8.0 × 7.6 cm, 8.5 × 8.9 × 8.5 cm, and 8.3 × 10.1 × 6.9 cm) visited our hospital because of vaginal bleeding, and received dilation and curettage. Pathological examination revealed endometrial carcinoma. DIAGNOSES: Endometrial carcinoma, obesity. INTERVENTION: Laparoscopy and transverse-abdominal extra-fascial hysterectomy were performed. First, we performed bilateral adnexectomy, pelvic lymph node dissection, and para-aortic lymph node sampling, and exposed and separated the para-uterine tissue and bladder before cutting off the uterus from the vagina through laparoscopy. Second, we made a 10 cm suprapubic transverse incision in the lower abdomen, clamped the vagina using right-angle forceps to follow the principle of tumor-free technique, placed the uterus in a surgical bag for retrieval the uterus immediately from the incision. OUTCOME: All 3 patients underwent intestinal recovery for 24 hours post operation; 50 mL blood was lost during the operation with a well-healing wound and no complication. Till date, there has been no recurrence or metastasis in any of them. LESSONS: Improving the surgical procedure could enhance safety and ease of operation even in cases of obesity and a large uterus.