Preoperative assessment of factors associated with difficulty in performing total laparoscopic hysterectomy.
OBJECTIVE
Our objective was to determine the preoperative factors associated with difficulty in total laparoscopic hysterectomy (TLH).


METHODS
This retrospective clinical study included 157 patients who underwent TLH for leiomyoma or adenomyosis between 2009 and 2013. All patients underwent magnetic resonance imaging (MRI) before surgery. We categorized patients as 'difficult' if the operation time was > 243 min, if total blood loss was > 500 mL, or if conversion to laparotomy was necessary. Preoperative information, including MRI findings, was compared between the difficult and 'other' patients. Stepwise logistic regression analysis was used to control for covariates that were significant on univariate analysis (P < 0.05).


RESULTS
The presence of an endometrioma, a previous cesarean section (CS), a wide uterus, and a high body mass index were independent risk factors for being a difficult patient. For adenomyosis patients, the presence of an endometrioma, a prior CS, subtype II adenomyosis, and high body mass index were independent risk factors for being a difficult patient. For leiomyoma patients, the presence of an endometrioma, a prior CS, and having at least seven leiomyomas were independent risk factors for being a difficult patient. All laparotomy conversion patients had multiple risk factors.


CONCLUSIONS
We have elucidated the factors associated with difficult TLH patients using patients' background and preoperative MRI findings. Awareness of these predictive factors may enable surgeons to prepare for the operation, minimize complications, or choose another more appropriate route of hysterectomy than TLH.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Ako
A
Saito
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Tetsuya
T
Hirata
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Kaori
K
Koga
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Masashi
M
Takamura
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Shinya
S
Fukuda
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Kazuaki
K
Neriishi
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Gia
G
Pastorfide
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Miyuki
M
Harada
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Yasushi
Y
Hirota
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Osamu
O
Wada-Hiraike
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Tomoyuki
T
Fujii
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Yutaka
Y
Osuga
D062788:Adenomyosis / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019990:Perioperative Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000601:surgery*
adenomyosis; laparoscopic hysterectomy; leiomyoma; magnetic resonance imagingpreoperative assessmentsurgical outcome