Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy

J Minim Invasive Gynecol. 2005 Jul-Aug;12(4):312-7. doi: 10.1016/j.jmig.2005.05.015.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Female
  • Humans
  • Hysterectomy / methods*
  • Laparoscopy*
  • Laparotomy*
  • Logistic Models
  • Menorrhagia / surgery
  • Metrorrhagia / surgery
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Uterine Hemorrhage / surgery*