title: Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy.
abstract: 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).
  
  
  METHODS
  Retrospective comparative study (Canadian Task Force classification II-2).
  
  
  METHODS
  University tertiary referral center for gynecologic endoscopic surgery.
  
  
  METHODS
  Four hundred sixteen consecutive patients who underwent TLH during the first 5 years of our experience performing TLH.
  
  
  METHODS
  Total laparoscopic hysterectomy.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Service de Gynécologie Obstétrique II, Unité de Chirurgie Gynécologique, CHU Cochin Port-Royal, Groupe Hospitalier Universitaire (GHU) Ouest, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris France.
authors.forename: Franck
authors.initials: F
authors.lastname: Leonard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chopin
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
authors.forename: Adolphe
authors.initials: A
authors.lastname: Fotso
authors.forename: Hervé
authors.initials: H
authors.lastname: Foulot
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mignon
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007813:Laparotomy; D016015:Logistic Models; D008595:Menorrhagia / Q000601:surgery; D008796:Metrorrhagia / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014592:Uterine Hemorrhage / Q000601:surgery*