Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy.
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.
Leonard
Franck
F
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.
Chopin
Nicolas
N
Borghese
Bruno
B
Fotso
Adolphe
A
Foulot
Hervé
H
Coste
Joël
J
Mignon
Alexandre
A
Chapron
Charles
C
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*