Risk Factors Associated with Major Complications of Total Laparoscopic Hysterectomy

Objectives: To determine risk factors associated with major complications of Siriraj total laparoscopic hysterectomy (SiTLH) technique. Materials and Methods: A case-control study was conducted in 275 women who underwent SiTLH at a university-based tertiary care hospital. Cases consisted of 55 women with major intraoperative complications. Controls were 220 women with the uneventful operation, randomly selected from those who underwent SiTLH during the same period as cases. Data were retrieved from medical records, including baseline and operative characteristics, diagnosis and indications, surgeon experience, and characteristics of the complications. Results: Cases and controls were comparable in terms of baseline characteristics, including age, body mass index, diagnosis, and surgeon’s experience. Cases were significantly more likely to have previous abdominal surgery and have preoperative diagnosis of endometriosis. (41.8% vs 25%, p = 0.013 and 47.3% vs 29.5%, p = 0.012, respectively). In addition, cases were significantly more likely to have higher specimen weight, longer operative time, and estimated blood loss (p < 0.001). Among those with major complications, internal organ injuries occurred in 30 cases (54.5%) including injuries to bowel (21.8%), bladder (18.2%), and ureters (16.4%). Conversion to abdominal operation occurred in 32.7%. Multivariate analysis showed that, after adjusting for potential confounders, having had previous abdominal surgery and preoperative diagnosis of endometriosis independently increased risk of major complications (adjusted odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2-4.29, p = 0.015 and adjusted OR 2.1, 95%CI 1.1-4.1, p = 0.019, respectively). Conclusion: Having had previous abdominal surgery and preoperative diagnosis of endometriosis independently increased the risk of major complications of SiTLH procedure.