Assessing Perioperative Risk According to Surgical Route in Hysterectomy for Very Large Uteri

The benefits of minimally invasive hysterectomy are widely recognized. However, laparoscopic hysterectomy is more technically difficult in patients with enlarged uteri. In this study, we sought to compare surgical outcomes for patients with large uteri (greater than 1 kg) undergoing laparoscopic versus open hysterectomy.

This was a retrospective cohort study performed at a tertiary-care academic center, including all patients who underwent laparoscopic or open hysterectomy for a benign indication between January 1, 2009 and December 31, 2024. The primary outcome was a composite measure of intraoperative and postoperative complications, readmissions, and reoperations.

A total of 509 patients underwent hysterectomy for uteri larger than 1 kg: 268 via laparotomy and 241 via laparoscopy. After controlling for confounding variables, the risk of any complication, readmission or reoperation was similar in the laparoscopy and laparotomy groups (OR 1.09 [0.68-1.77], P = .7119). Median estimated blood loss was lower in the laparoscopy group as compared to the laparotomy group (100 vs 300 mL, P < .001). Mean operative time was longer in the laparoscopy group by 24 minutes (188 vs 164 minutes, P < .001). The median length of stay was 0 days for the laparoscopy group, versus 2 days for the laparotomy group (P < .001).

Our results suggest that laparoscopic hysterectomy is feasible even for patients with uterine weight exceeding 1 kg. While operative time was longer in the laparoscopy group, this increase in operative time was not associated with an increase in perioperative complications.