{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:42:22Z","timestamp":1762868542762,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T00:00:00Z","timestamp":1622505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Specimen extraction is a major challenge in total laparoscopic hysterectomy (TLH) and tissue morcellation may be needed to extract a large uterus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The study aims to determine preoperative factors that could predict the need for uterine morcellation in TLH, and also find the best cut\u2010off values of each measured parameter leading to optimum sensitivity and specificity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This was a cross\u2010sectional study of women from August 2019 to May 2020 who underwent TLH, with or without salpingo\u2010oophorectomy in our department. We performed bimanual exams preoperatively to estimate the uterine size and recorded the uterine ultrasonographic dimensions and myoma size in myomatous uteri. Receiver operating characteristic (ROC) were used to establish cut\u2010offs that maximised the sensitivity and specificity of each factor in predicting the need for morcellation. Poisson regression was used to calculate the relative risks (RR) of each cut\u2010off.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and sixty\u2010two women were recruited in the study. ROC curves demonstrated maximum sensitivities and specificities with a cross\u2010sectional area of 36.5\u00a0cm<jats:sup>2<\/jats:sup>, the largest leiomyoma dimension of 40\u00a0mm, uterine length of 10\u00a0cm, and bimanual uterine size of 13\u00a0weeks. Multiple modified Poisson regression revealed that the strongest predictors of morcellation were the largest leiomyoma diameter of &gt;40\u00a0mm (RR: 3.58), the uterine cross\u2010sectional area of &gt;36.5\u00a0cm<jats:sup>2<\/jats:sup> (RR: 6.38), and uterine size in the bimanual exam of &gt;13\u00a0weeks pregnancy (RR: 3.57).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The largest leiomyoma diameter, uterine cross\u2010sectional area, and size on a bimanual exam can all be used to predict needing morcellation preoperatively in TLH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13378","type":"journal-article","created":{"date-parts":[[2021,6,1]],"date-time":"2021-06-01T07:51:35Z","timestamp":1622533895000},"page":"759-764","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Predictive factors of the need to morcellate in total laparoscopic hysterectomy"],"prefix":"10.1111","volume":"61","author":[{"given":"Zahra","family":"Asgari","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arash Women's Hospital Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9129-3395","authenticated-orcid":false,"given":"Anahita","family":"Enzevaei","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arash Women's Hospital Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reihaneh","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Arash Women's Hospital Tehran University of Medical Sciences Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fariba","family":"Behnia\u2010Willison","sequence":"additional","affiliation":[{"name":"Senior endo\u2010gynaecologist at Flinders Medical Centre and Senior lecturer at Flinders University Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_7_2_1","DOI":"10.1016\/j.jmig.2014.09.005"},{"doi-asserted-by":"publisher","key":"e_1_2_7_3_1","DOI":"10.1016\/j.ajog.2014.11.020"},{"doi-asserted-by":"publisher","key":"e_1_2_7_4_1","DOI":"10.1016\/j.jmig.2017.04.023"},{"key":"e_1_2_7_5_1","first-page":"8784601","article-title":"Total laparoscopic hysterectomy in patients with large uteri: comparison of uterine removal by transvaginal and uterine morcellation approaches","volume":"2016","author":"Wang H","year":"2016","journal-title":"Biomed Res Int"},{"doi-asserted-by":"publisher","key":"e_1_2_7_6_1","DOI":"10.1016\/j.jmig.2017.09.015"},{"doi-asserted-by":"publisher","key":"e_1_2_7_7_1","DOI":"10.1016\/j.jmig.2017.07.030"},{"doi-asserted-by":"publisher","key":"e_1_2_7_8_1","DOI":"10.1016\/j.ygyno.2014.11.011"},{"unstructured":"US Food and Drug Administration.Quantitative assessment of the prevalence of unsuspected uterine sarcoma in women undergoing treatment of uterine fibroids. April 17 2014","key":"#cr-split#-e_1_2_7_9_1.1"},{"unstructured":"[cited 2020 Nov 19]. Available from:https:\/\/www.fda.gov\/media\/88703\/download","key":"#cr-split#-e_1_2_7_9_1.2"},{"unstructured":"The American College of Obstetricians and Gynecologists ACOG Clinical Committee Opinion; March 2021.Uterine morcellation for presumed leiomyomas. [cited 2021 March 13] Available from:https:\/\/www.acog.org\/clinical\/clinical\u2010guidance\/committee\u2010opinion\/articles\/2021\/03\/uterine\u2010morcellation\u2010for\u2010presumed\u2010leiomyomas","key":"e_1_2_7_10_1"},{"doi-asserted-by":"publisher","key":"e_1_2_7_11_1","DOI":"10.1016\/j.jmig.2006.12.001"},{"doi-asserted-by":"publisher","key":"e_1_2_7_12_1","DOI":"10.1016\/j.jmig.2015.08.712"},{"key":"e_1_2_7_13_1","first-page":"387","volume-title":"Te Linde's Operative Gynecology","author":"Anderson TL","year":"2020"},{"issue":"3","key":"e_1_2_7_14_1","first-page":"247","article-title":"Laparoscopic versus abdominal hysterectomy","volume":"37","author":"Nezhat F","year":"1992","journal-title":"J Reprod Med"},{"doi-asserted-by":"publisher","key":"e_1_2_7_15_1","DOI":"10.1016\/j.jmig.2008.09.618"}],"container-title":["Australian and New Zealand Journal of Obstetrics and Gynaecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.13378","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ajo.13378","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ajo.13378","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T07:10:47Z","timestamp":1693293047000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/ajo.13378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1111\/ajo.13378"],"URL":"https:\/\/doi.org\/10.1111\/ajo.13378","archive":["Portico"],"relation":{},"ISSN":["0004-8666","1479-828X"],"issn-type":[{"type":"print","value":"0004-8666"},{"type":"electronic","value":"1479-828X"}],"subject":[],"published":{"date-parts":[[2021,6]]},"assertion":[{"value":"2020-11-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}