Fast Track

Risk of injury to the bowel may be heightened in women who have a large uterus

Trendelenburg position allows the intestines to drop out of the pelvis and into the upper abdomen, facilitating visualization and reducing the risk of bowel injury

All types of abdominal entry remain safe as long as laparoscopic surgical principles are followed scrupulously

The 45° laparoscope offers better visual access to the low lateral uterine blood supply and bladder flap

If the uterine blood supply is adequately controlled, the large uterus can be morcellated without excessive blood loss

Attempt morcellation in the anterior abdominal space to avoid injury to blood vessels, ureters, and bowel in the posterior abdominal space

Uterine manipulation by the assistant during morcellation keeps the uterus away from critical structures as it is reduced to 8 to 10 weeks’ size