Laparoscopic hysterectomy safest even for markedly enlarged uteri

ORLANDO – The complication rate is lower with laparoscopic hysterectomy than with abdominal or vaginal hysterectomy – even for uteri over 500 g, according to findings from a nationwide cohort of more than 27,000 women.

After adjusting for numerous potential confounding factors, including medical risk factors, procedure-related variables, and patient demographics, increasing uterine weight was significantly associated with increasing odds of complications – particularly after hysterectomy for uteri over 500 g, Michelle Louie, MD, reported during an oral poster session at the annual scientific meeting of the Society of Gynecologic Surgeons.

Sharon Worcester/Frontline Medical News

For example, compared with uteri of 25 g or less, the adjusted odds ratios for a composite outcome of any 30-day postsurgical complication were 1.02, 1.08, 1.23, 1.47, and 1.84 for uteri at 100 g, 250 g, 500 g, 750 g, and 1000 g or greater, respectively. However, for uteri over 500 g, laparoscopic hysterectomy was associated with the lowest odds of any complication when compared with abdominal and vaginal hysterectomy (adjusted OR, 1.61, 2.16, and 2.57, respectively), said Dr. Louie of the University of North Carolina at Chapel Hill.

The same was true for uteri of 250-500 g (adjusted OR, 0.99, 1.73, and 1.06, respectively), she noted, adding that “abdominal hysterectomy always has the highest rate of a complication, except at above 850 g, when a vaginal hysterectomy is associated with a greater odds of complications.”