Outpatient laparoscopic hysterectomy for large uteri

To determine the incidence of perioperative complications associated with laparoscopic hysterectomies performed for very large uteri on an outpatient basis.

A retrospective chart review of consecutive women who underwent total laparoscopic (TLH) or supracervical laparoscopic (LSH) hysterectomy with uterine weight ≥ 500 grams. Clinical, demographic, and surgical characteristics were ascertained. Deviation from a normal intraoperative/perioperative course and readmission rate were assessed. Complications were graded by Dindo morbidity scale. Surgical characteristics and complications were compared between TLH and LSH groups using Chi2 tests for categorical and unpaired t tests for continuous variables. Logistic regressions were performed to identify specific risk factors.

TLH and LSH were performed in 113 (25.3%) and 333 (74.7%) cases, respectively, with no differences in baseline characteristics between the groups. Median uterine weight was 786 gm (range: 500-4500). Mean operative time was 27 minutes longer in the TLH group: 186.5 ± 58.6 vs. 159.6 ± 53.8 minutes for LSH (P < 0.0001). Life threatening complications (Dindo's grade IV morbidity) occurred in 0.7%. Surgical intervention requiring general anesthesia (IIIB) occurred in 0.45% of cases. Visceral injury was limited to 6 (1.3%) cases of cystotomy. The rate of vascular injury was 0.22%. Conversion to laparotomy occurred in 3.4% of cases. 92.8% of patients were discharged on post-operative day zero, with 1.1% readmission rate. There was no association between perioperative morbidity and patient/surgical characteristics.

Laparoscopic hysterectomy is a viable option for women with very large uteri. Same day discharge of clinically stable patients can be safely implemented.