Total laparoscopic hysterectomy: Preoperative risk factors for conversion to laparotomy

Abstract Study objective To identify the preoperative factors affecting the risk of conversion to laparotomy during total laparoscopic hysterectomy (TLH) indicated for benign conditions (surgery performed in cases of genital prolapse and/or urinary stress incontinence was excluded). Design Retrospective comparative study (Canadian Task Force classification II-2). Setting University tertiary referral center for gynecologic endoscopic surgery. Patients Four hundred sixteen consecutive patients who underwent TLH during the first 5 years of our experience performing TLH. Intervention Total laparoscopic hysterectomy. Measurements and main results The rate of conversion to laparotomy was 7% (29 patients). Factors that were found to be independently related to the risk of conversion to laparotomy are the following: body mass index (adjusted OR 1.09; 95% CI 1.01–1.18); uterine width on transvaginal ultrasonography (US) between 8 and 10 cm (adjusted OR 4.01; 95% CI 1.54–10.45); uterine width on US greater than 10 cm (adjusted OR 9.17; 95% CI 2.74–30.63); lateral myoma measuring greater than 5 cm on US (adjusted OR 3.57; 95% CI 0.97–13.17); history of adhesion-causing abdominopelvic surgery (adjusted OR 2.92; 95% CI 1.23–6.94). Conclusion Transvaginal US evaluation is essential before performing TLH. Awareness of the risk factors for conversion to laparotomy is essential for proper patient information and better selection of patients.