Surgical Field Separation in Total Laparoscopic Hysterectomy

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Infection Control

Background:

• Surgical site infections (SSIs) are a concern in gynecologic procedures.
• Total laparoscopic hysterectomy (TLH) involves abdominal and vaginal surgical sites.
• The practice of separating these fields during TLH is debated regarding its impact on infection rates.

Purpose of the Study:

• To investigate the association between surgical field separation and SSI rates in patients undergoing TLH.
• To evaluate the safety and efficacy of a continuous operative field approach during TLH.

Main Methods:

• Retrospective cohort study including 680 patients who underwent TLH between January 2016 and May 2023.
• Data collected from procedures performed by two minimally invasive gynecologic surgery subspecialists.
• Comparison of SSI rates between patients with and without surgical field separation.

Main Results:

• The overall infection rate was low in both groups: 0.8% with surgical field separation (3/377) and 1.3% without (4/303).
• The odds ratio for infection with field separation was 0.60 (95% CI, 0.13-2.70), indicating no statistically significant difference.
• The study had inadequate statistical power to detect small differences in infection rates.

Conclusions:

• Surgical site infection rates after TLH are low, irrespective of whether vaginal and abdominal fields are separated.
• Treating the vagina, perineum, and abdomen as a single operative field during TLH appears to be an acceptable practice.
• Further research with larger sample sizes may be needed to definitively confirm the absence of a small difference in infection risk.