Predictive factors for conversion to laparotomy in women undergoing laparoscopic hysterectomy. An evaluation of clinicopathological factors in the era of minimally invasive gynecology.

Abstract

Abstract Background: Abdominal hysterectomy by laparotomy has been largely replaced by minimal invasive surgery. Nevertheless, in some situations a minimally invasive intervention must be converted to laparotomy. Factors associated with conversion to laparotomy are still a matter of debate. The aim of this study is to evaluate the clinicopathological factors for conversion and to develop a preoperative scoring system predicting the likelihood of laparotomy.Methods: Four hundred forty-one patients who underwent hysterectomy by benign diagnosis in the period of 2016 to 2020 were enrolled in this retrospective analysis. Primary endpoint was to reevaluate the rate and risk factors of conversion of a preplanned laparoscopic procedure to laparotomy. The potential predictive factors such as age, BMI, type of diagnosis, surgeon’s experience, uterus weight, leiomyoma size, previous surgeries, and coagulopathies are studied. Associations between the clinical factors were analyzed using Pearson’s chi-square and Fisher’s exact test.Result: In 32 (7.26%) patients during hysterectomy for benign diagnosis conversion to laparotomy occurred. Significant differences were detected for uterus weight, myoma size, and type of diagnosis. Conversion caused prolonged surgery time and hospital stay, as well as an increased rate of wound infection. In multivariate logistic regression uterus weight, adnexal pathology, non-physiological adhesions, and myoma size predicted conversion. A 10-gramm difference in uterus weight increased the risk of conversion by 7.0%, and a 1-cm difference in leiomyoma diameter by 7.3%, while adnexal findings and extensive adhesions displayed odds ratios of 3.2 (1.09–9.6) and 3.6 (1.3–10.0), respectively.Conclusion: Uterus weight, myoma size, simultaneous pathological adnexal findings, and non-physiological adhesions are independent risk factors for conversion from laparoscopy to laparotomy.