Perioperative outcomes in laparoscopic hysterectomy: identifying surgical risk factors

This study aimed to evaluate the effect of surgical risk factors, including type of surgery, body mass index, uterine size and presence of adhesions, on perioperative outcomes and complication rates in laparoscopic hysterectomy (LH). This was a retrospective cohort study of 264 LH cases performed between 2005 and 2013 at a London University Hospital. One hundred sixty six (62.9 %) underwent laparoscopic subtotal hysterectomy (LASH) and 98 (37.1 %) total laparoscopic hysterectomy (TLH). Mean operation duration was 77 (±35) min and mean estimated blood loss (EBL) was 196 (±128) ml. Mean specimen weight was 323 g (range 46–1765 g). There were no conversions to laparotomy. Patients undergoing LASH were older than TLH patients (46.7 vs 42.8 years, p < 0.0001) and with larger uterine size (16.9 vs 11.0 weeks, p < 0.0001). There were no differences in operation duration, EBL or hospital stay. Bladder injury occurred in 3 LASH cases (1.8 %) and no TLH cases. Presence of adhesions increased operative duration (95.2 vs 71.5 min, p < 0.0001). Preoperative uterine size correlated positively with specimen weight (p < 0.001), operation duration (p < 0.001) and EBL (p < 0.001). There was a linear relationship between BMI and EBL and operation duration (EBL r 2 0.028, p = 0.006; operative duration r 2 0.017, p = 0.038). This study shows that overall, LH is a safe procedure with low risk of major complications, even in patients with significant surgical risk factors. This study has highlighted particular groups which might be at increased surgical risk, particularly those with a combination of elevated BMI and large uterus, which can aid preoperative counselling.