Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery

Obstet Gynecol. 2010 Oct;116(4):956-961. doi: 10.1097/AOG.0b013e3181f240f7.


Objective: To estimate the incidence of venous thromboembolism among patients undergoing gynecologic laparoscopy and characterize the risk of venous thromboembolism among patients with gynecologic malignancy.

Methods: Data were collected for patients who underwent laparoscopic gynecologic surgery from January 2000 to January 2009. Incidence of deep vein thrombosis (DVT) or pulmonary embolism diagnosed within 6 weeks of surgery was estimated. Fisher's exact test was used to estimate the association between the presence of perioperative venous thromboembolism and categorical variables.

Results: Six (of 849) patients developed symptomatic venous thromboembolism (0.7%, 95% confidence interval: 0.024-1.44%). The median time to diagnosis of venous thromboembolism was postoperative day 15.5 (range, 1-41 days), median body mass index was 25.4 kg/m (range, 18.4-50 kg/m), median operative time was 176 minutes (range, 53-358 minutes), and median estimated blood loss was 125 mL (range, 10-250 mL). Five of 430 (1.2%) patients with a history of gynecologic malignancy developed postoperative thromboembolic events. Venous thromboembolism was diagnosed in three of 662 (0.5%) patients undergoing intermediate complexity procedures and three of 106 (2.8%) patients undergoing high-complexity procedures. Three patients with venous thromboembolism (50%) had a history of at least one previous modality of cancer treatment before laparoscopy. One patient (17%) had DVT only, four (67%) had pulmonary emboli without an identified DVT, and one (17%) had both. There were no associated mortalities.

Conclusion: The incidence of thromboembolism in patients undergoing low- and intermediate-complexity, minimally invasive surgery was low, even among patients with a gynecologic malignancy. Patients undergoing high-complexity, minimally invasive procedures may benefit from postoperative anticoagulation.

Level of evidence: II.

MeSH terms

  • Adult
  • Aged
  • Blood Loss, Surgical / statistics & numerical data
  • Body Mass Index
  • Female
  • Genital Neoplasms, Female / surgery*
  • Gynecologic Surgical Procedures / adverse effects*
  • Humans
  • Incidence
  • Laparoscopy
  • Male
  • Middle Aged
  • Pulmonary Embolism / epidemiology
  • Retrospective Studies
  • Risk Assessment
  • Venous Thromboembolism / epidemiology*
  • Venous Thrombosis / epidemiology