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Updated: Jul 7, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
When is laparotomy needed in hysterectomy for benign uterine disease?
Michel Canis1, Revaz Botchorishvili, Catarina Ang
1CHU Clermont-Ferrand, Department of Obstetrics Gynecology and Reproductive Medicine Polyclinique de l'Hôtel Dieu, Clermont-Ferrand, France. mcanis@chu-clermontferrand.fr
Study Objective:
We sought to study laparotomy (conversion and initial) and complication rates among patients who underwent hysterectomy initially performed laparoscopically whenever feasible.
Design:
A retrospective cohort study (Canadian Task Force classification II-3).
Setting:
University hospital.
Patients:
A continuous series of 680 patients, operated on between January 1, 2000, and December 31, 2003, was analyzed. Patients with malignancy and prolapse were excluded.
Interventions:
Hysterectomy.
Measurements And Main Results:
Overall, 7.2% of patients underwent laparotomy. In all, 27 (3.9%) patients were treated by initial laparotomy and 22 procedures were converted to laparotomy, 13 to laparoscopic-assisted vaginal hysterectomy (1.9%). Intraoperative and postoperative bladder complication rates were 0.8% and 0.4%, respectively. Ureteric complications were 0.3% and 0.4%, respectively, and bowel complications (bowel occlusion, peritonitis) were 0.4% and 0.4%, respectively. Three patients received blood transfusion. Of 19 patients who had repeated surgery for early or late postoperative complications, 13 were treated by laparoscopy and/or vaginally.
Conclusion:
Including management of complications, laparotomy was necessary in 8.1% of cases. Laparoscopic hysterectomy may be safely used in most patients.
