Risk Profiles and Outcomes of Total Laparoscopic Hysterectomy Compared With Laparoscopically Assisted Vaginal Hysterectomy

Hanwright, Philip J. BA; Mioton, Lauren M. BS; Thomassee, May S. MD; Bilimoria, Karl Y. MD; Van Arsdale, John MD; Brill, Elizabeth MD; Kim, John Y.S. MD

doi: 10.1097/AOG.0b013e3182887f4e
Original Research

OBJECTIVE: With the increasing rates of minimally invasive hysterectomy procedures serving as impetus, the aim of this study was to analyze the 30-day risk profiles associated with total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH).

METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent a total laparoscopic hysterectomy or LAVH operation between 2006 and 2010. Patient demographics and 30-day complication rates were calculated. Multivariable regression analyses were used to study the effect of hysterectomy approach on outcomes.

RESULTS: A total of 6,190 patients underwent laparoscopic hysterectomy, with 66.3% receiving LAVH and 33.7% receiving a total laparoscopic hysterectomy. The patient cohorts were well-matched. Although total laparoscopic hysterectomy procedures were significantly longer than LAVH operations (2.66 hours compared with 2.20 hours; P<.001), there was no difference in overall morbidity or reoperation rates between the LAVH and total laparoscopic hysterectomy populations (7.05% compared with 6.3% for overall morbidity; 1.3% compared with 1.7% for reoperation). Regression analyses revealed that surgical approach was not a significant predictor of overall postoperative morbidity or reoperation in minimally invasive hysterectomy patients. Additionally, obesity did not demonstrate a significant association with morbidity or reoperation rates; however, operative time was found to be a significant predictor of reoperation (odds ratio 1.23, 95% confidence interval 1.07–1.42).

CONCLUSION: Laparoscopic hysterectomy is well-tolerated with total laparoscopic hysterectomy and LAVH, yielding comparable rates of postoperative morbidity and reoperation. On average, LAVH procedures were 28 minutes faster than total laparoscopic hysterectomy. Additionally, increasing body mass index was not associated with higher rates of morbidity.

LEVEL OF EVIDENCE: II

Total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy approaches demonstrate equivalent rates of perioperative morbidity and reoperations.

Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; and Vanderbilt School of Medicine and the Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee.

Corresponding author: John Y.S. Kim, MD, Department of Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair Street, Galter Suite 19-250, Chicago, IL 60611; e-mail: jokim@nmh.org.

Financial Disclosure Lauren M. Mioton is funded by a research scholarship through Vanderbilt University School of Medicine by NIH CTSA grant UL1RR024975. The other authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists