Skip to main content
SpringerLink
Log in

Outcomes of vaginal and laparoscopic hysterectomy with concomitant pelvic reconstructive surgery

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Introduction and hypothesis

Although vaginal hysterectomy(VH) is traditionally considered the safest route of hysterectomy, newer data suggest that laparoscopic hysterectomy (LH) might have lower risks of perioperative complications in contemporary practice. Using a large surgical database, we aimed to assess the hypothesis that there are no significant differences in rates of major and minor complications between LH and VH when performed with pelvic reconstructive surgery, controlling for the number and type of pelvic reconstructive procedures.

Methods

A total of 27,941 eligible LH and VH from the 2010–2018 National Surgical Quality Improvement Program database were identified. Concomitant pelvic reconstructive surgery was defined as either an apical suspension, enterocele repair, or colporrhaphy. Laparoscopy-assisted VH, gynecological malignancy, and concomitant nongynecological procedures were excluded. Complications within 30 days of surgery were grouped into major (Clavien–Dindo grade ≥3) or minor (grade 1–2) classifications. Bivariate analysis and inverse propensity-weighted logistic regression compared the outcomes of the VH and LH groups. Cochran–Armitage tests and multivariate regression assessed changes over time.

Results

The majority of hysterectomies (72%) were vaginal, although its utilization declined from 89% in 2010 to 64% in 2018 (p < 0.001). In multivariate analysis controlling for patient factors and the type and number of concomitant pelvic reconstructive procedures, LH was associated with a lower odds of major (adjusted odds ratio [aOR] 0.711, 95% confidence interval [CI]:0.639–0.791) and minor (aOR 0.659, 95% CI: 0.612–0.710) complications.

Conclusions

Relative safety profiles should be considered among other patient factors when counseling women undergoing surgical prolapse repair. Our findings suggest that laparoscopic approaches can be safely utilized among older and sicker patients traditionally counseled toward a vaginal approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Geller EJ, Siddiqui NY, Wu JM, Visco AG. Short-term outcomes of robotic sacrocolpopexy compared with abdominal sacrocolpopexy. Obstet Gynecol. 2008;112(6):1201–6. https://doi.org/10.1097/AOG.0b013e31818ce394.

    Article  PubMed  Google Scholar 

  2. Pollard ME, Eilber KS, Anger JT. Abdominal approaches to pelvic prolapse repairs. Curr Opin Urol. 2013;23(4):306–11. https://doi.org/10.1097/MOU.0b013e3283619e36.

    Article  PubMed  Google Scholar 

  3. McDermott CD, Hale DS. Abdominal, laparoscopic, and robotic surgery for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):585–614. https://doi.org/10.1016/j.ogc.2009.09.004.

    Article  Google Scholar 

  4. Luchristt D, Brown O, Kenton K, Bretschneider CE. Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018. Am J Obstet Gynecol. 2020;224(2):202.e1-12. https://doi.org/10.1016/j.ajog.2020.08.014.

    Article  Google Scholar 

  5. Morgan DM, Kamdar NS, Swenson CW, Kobernik EK, Sammarco AG, Nallamothu B. Nationwide trends in the utilization of and payments for hysterectomy in the United States among commercially insured women. Am J Obstet Gynecol. 2018;218(4):425.e1–18. https://doi.org/10.1016/j.ajog.2017.12.218.

    Article  Google Scholar 

  6. Fairchild PS, Kamdar NS, Berger MB, Morgan DM. Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse. Am J Obstet Gynecol. 2016;214(2):262.e1–7. https://doi.org/10.1016/j.ajog.2015.08.053.

    Article  Google Scholar 

  7. National Surgical Quality Improvement Participant use File. 2020.

  8. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res. 2011;46(3):399–424. https://doi.org/10.1080/00273171.2011.568786.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009;28(25):3083–107. https://doi.org/10.1002/sim.3697.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mowat A, Maher C, Ballard E. Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and meta-analysis. Am J Obstet Gynecol. 2016;215(1):21–33. https://doi.org/10.1016/j.ajog.2016.02.048.

    Article  PubMed  Google Scholar 

  11. Vree FE, Cohen SL, Chavan N, Einarsson JI. The impact of surgeon volume on perioperative outcomes in hysterectomy. JSLS. 2014;18(2):174–81. https://doi.org/10.4293/108680813X13753907291594.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Committee opinion no. 701: choosing the route of hysterectomy for benign disease. Obstet Gynecol 2017;129(6):e155–9. https://doi.org/10.1097/AOG.0000000000002112.

  13. Chapman GC, Slopnick EA, Roberts K, Sheyn D, Wherley S, Mahajan ST, Pollard RR. National analysis of perioperative morbidity of vaginal versus laparoscopic hysterectomy at the time of uterosacral ligament suspension. J Minim Invasive Gynecol. 2020;28(2):275–81. https://doi.org/10.1016/j.jmig.2020.05.015.

    Article  PubMed  Google Scholar 

  14. Banks E, Gressel GM, George K, Woodland MB. Resident and program director confidence in resident surgical preparedness in obstetrics and gynecologic training programs. Obstet Gynecol. 2020;136(2):369–76. https://doi.org/10.1097/AOG.0000000000003990.

    Article  PubMed  Google Scholar 

  15. Klebanoff JS, Marfori CQ, Vargas MV, Amdur RL, Wu CZ, Moawad GN. Ob/Gyn resident self-perceived preparedness for minimally invasive surgery. BMC Med Educ. 2020;20(1):185. https://doi.org/10.1186/s12909-020-02090-9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Burkett D, Horwitz J, Kennedy V, Murphy D, Graziano S, Kenton K. Assessing current trends in resident hysterectomy training. Female Pelvic Med Reconstr Surg. 2011;17(5):210–4. https://doi.org/10.1097/SPV.0b013e3182309a22.

    Article  PubMed  Google Scholar 

  17. Cadish LA, Kropat G, Muffly TM. Hysterectomy volume among recent obstetrics and gynecology residency graduates. Female Pelvic Med Reconstr Surg. 2021;27(6):382–7. https://doi.org/10.1097/SPV.0000000000000879.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Urogynecology, Duke University School of Medicine, 5324 McFarland Dr, Ste 310, Durham, NC, 27707, USA

    Douglas Luchristt

  2. Division of Female Pelvic Medicine and Reconstructive Surgery, Northwestern University, Chicago, IL, USA

    Kimberly Kenton & C. Emi Bretschneider

Authors
  1. Douglas Luchristt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly Kenton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Emi Bretschneider
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

D.L.: project development, data analysis, manuscript writing; K.K.: project development, manuscript writing; C.E.B.: project development, manuscript writing.

Corresponding author

Correspondence to Douglas Luchristt.

Ethics declarations

Financial disclaimers/conflicts of interest

All authors declare that they have no conflicts of interest related to this publication. D.L. has no other disclosures. K.K. is an expert witness for Current Butler Snow and Ethicon. C.E.B. is a consultant for Boston Scientific.

Financial support

None.

Ethics

IRB exempt, as reviewed by Northwestern University IRB: STU00212227.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 12 kb)

ESM 2

(DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luchristt, D., Kenton, K. & Bretschneider, C.E. Outcomes of vaginal and laparoscopic hysterectomy with concomitant pelvic reconstructive surgery. Int Urogynecol J 33, 3005–3011 (2022). https://doi.org/10.1007/s00192-021-05069-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-05069-2

Keywords

Search

Navigation