Archives of Gynecology and Obstetrics

, Volume 300, Issue 1, pp 183–189 | Cite as

Hidden blood loss and its risk factors in patients undergoing laparoscopy and laparotomy for cervical cancer management

  • Yu Zhao
  • Jianing Hu
  • Junmiao Xiang
  • Wenju Li
  • Xiujie Zhu
  • Min Zhao
  • Rongjiao Sun
  • Yue HuEmail author
  • Qiong ZhangEmail author
Gynecologic Oncology



Laparoscopy and laparotomy are the two most common surgical options used to treat women with early-stage cervical cancer. This study aimed to examine the volume of hidden blood loss (HBL) between laparoscopy and laparotomy for cervical cancer and to identify its risk factors.


Sixty-one patients treated with laparotomy and 50 patients treated with laparoscopy were enrolled in this study. Their medical data were collected to calculate the HBL according to the Nadler and Gross formula, and its risk factors were identified by multiple linear regression analysis.


The visible blood loss was 574.9 ± 271.6 mL in the laparotomy surgery; however, the HBL was 345.2 ± 258.6 mL, accounting for 38.3 ± 21.4% of true TBL. The visible blood loss in the laparoscopy group was 168.9 ± 121.9 mL, and the HBL was 185.1 ± 130.5 mL (52.3 ± 28.1% of true TBL). The HBL blood loss in laparotomy was more than laparoscopy (p < 0.01). Multiple linear regression analysis suggested that patient age (p = 0.012), surgical time (p = 0.037) and pathological tumour type (p = 0.014) were independent risk factors contributing to HBL in laparotomy. Meanwhile, the following risk factors were positively correlated with HBL in laparoscopy: pre-operative value of Hb (p = 0.002), pre-operative value of Hct (p = 0.003), surgical time (p = 0.035), pathological tumour type (p = 0.036) and diabetes mellitus (p = 0.022). Ten and eight patients had pre-operative anaemia in the laparotomy group and the laparoscopy group, respectively, and 54 and 29 post-operatively.


HBL is seriously underestimated, and accounts for a large percentage of total blood loss both in laparotomy and laparoscopy for cervical cancer. Additionally, age, pathological tumour type, pre-operative value of Hb and Hct, surgical time and diabetes mellitus have the potential to increase HBL. A correct understanding of HBL can ensure patient safety and improve post-operative rehabilitation.


Cervical cancer Hidden blood loss Risk factor Laparoscopy Laparotomy 



Hidden blood loss


Abdominal radical hysterectomy


Intra-operative blood loss


Body mass index






Visible blood loss


Estimated blood volume


Total blood loss


Post-operative blood loss


Author contributions

YZ and WL conceived the study and developed the protocol. JH, XZ and JX collected data. YH and RS analysed data. QZ and MZ wrote and edited the manuscript. All authors read and approved the manuscript.


This study was financially supported by the Natural Science Foundation of Zhejiang Province [Grant No. LY18H040011, LY16H040011], the Public welfare science and technology project of Wenzhou City [Grant No.Y20150044, Y20170125], the Key Lab of Wenzhou city-Gynecological Oncology [Grant No. ZD201603].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study protocol was reviewed and approved by the Ethics Committee of Second Affiliated Hospital of Wenzhou Medical University.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynaecology and ObstetricsThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityWenzhouChina
  2. 2.The Second School of MedicineWenzhou Medical UniversityWenzhouChina

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