Factors determining conversion to laparotomy in patients undergoing total laparoscopic hysterectomy

To identify the risk factors determining conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases.

We retrospectively reviewed medical records of 288 patients that underwent TLH during the first 2 years of performing TLH at Kang-Nam Sacred Heart Hospital. Twenty-three cases were converted to laparotomy. We compared patient characteristics, indications for hysterectomy, operation time, estimated blood loss, adhesion, uterine weight and postoperative complications between failed and successful groups.

The rate of conversion to laparotomy was 8%. There were no differences in patient characteristics between the two groups. Independent risk factors for conversion were adhesion and uterine weight. The most common cause of the conversion to laparotomy was adhesions (p = 0.000). Uterine weight was found to be heavier in the failed group (331.5 ± 157.1 vs. 270.3 ± 132.5 g, p = 0.038). Estimated blood loss was greater in the failed group (455.6 ± 143.7 vs. 304.2 ± 45.8 ml, p = 0.047). Bladder injury occurred in the failed group more frequently than in the successful group (p = 0.024).

An awareness of risk factors for conversion is important for better patient selection for TLH. Indirect measurement of uterine weight by sonography and detailed history taking is helpful in determining the appropriate hysterectomy route.