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Total Laparoscopic Hysterectomy in Obese Versus Nonobese Patients

Heinberg, Eric M. MD, MPH; Crawford, Benjamin L. III MD; Weitzen, Sherry H. PhD; Bonilla, David J. MD

doi: 10.1097/01.AOG.0000119224.68677.72
Original Research

OBJECTIVE: To estimate the risk of operative and postoperative complications for obese patients undergoing total laparoscopic hysterectomy compared with nonobese patients.

METHODS: A retrospective cohort study was performed for patients undergoing total laparoscopic hysterectomy at Ochsner Clinic Foundation in New Orleans, Louisiana, for a period of 4.3 years. Rates of complications, successful laparoscopic completion, readmission, and reoperation were compared for those patients having a body mass index (BMI) of 30 kg/m2 or greater with those whose BMI was less than 30 kg/m2.

RESULTS: Of 270 patients who met inclusion criteria, 106 (39.3%) women had a BMI of 30 kg/m2 or greater. Procedures were completed by using endoscopic technique in 253 cases (93.7%), by using a combined vaginal approach (laparoscopically assisted vaginal hysterectomy) in 7 cases (2.6%), and via laparotomy (total abdominal hysterectomy) in 10 cases (3.7%). Neither the 2-fold risk of conversion to laparoscopically assisted vaginal hysterectomy (relative risk [RR] 2.2; 95% confidence interval [CI] 0.5, 10.1) nor the 4-fold risk of conversion to laparotomy (RR 3.9, 95% CI 1.0, 15.4) associated with obesity was statistically significant. Total laparoscopic hysterectomy for obese patients was 60% more likely to require at least 2 hours to complete (RR 1.6, 95% CI 1.2, 2.0) and was associated with a 3-fold risk of blood loss exceeding 500 mL compared with nonobese patients. Risks of major and minor complications, hospital readmission, and reoperation were similar for both groups.

CONCLUSION: Total laparoscopic hysterectomy can be performed successfully in most obese patients, with complication rates similar to those for nonobese patients.


Complication rates for total laparoscopic hysterectomy are similar for obese and nonobese patients.

From the Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans, Louisiana; and the Division of Research, Women and Infants’ Hospital, Providence, Rhode Island.

Address reprint requests to: Dr. Benjamin Crawford III, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121; e-mail:

Received September 28, 2003. Received in revised form January 8, 2004. Accepted January 16, 2004.

© 2004 The American College of Obstetricians and Gynecologists