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Updated: Aug 16, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy
Franck Leonard1, Nicolas Chopin, Bruno Borghese
1Service 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.
Study 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).
Design:
Retrospective comparative study (Canadian Task Force classification II-2).
Setting:
University tertiary referral center for gynecologic endoscopic surgery.
Patients:
Four hundred sixteen consecutive patients who underwent TLH during the first 5 years of our experience performing TLH.
Intervention:
Total laparoscopic hysterectomy.
Measurements And Main 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).
Conclusion:
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.