Low Complication Rate Associated with Total Laparoscopic Hysterectomies Using the Retroperitoneal Approach: A Series of 1,092 Cases in Siriraj Hospital

Objective: This study was performed to evaluate the incidence of and risk factors for major complications associated with the Siriraj total laparoscopic hysterectomy (SiTLH) technique. Methods: In total, 1,092 patients who underwent SiTLH from January 2009 to December 2013 were enrolled in this retrospective study. The incidence of major complications such as death, vascular injury, visceral injury was the main outcome. Comparison between the patients with and without complications was such as unintended laparoconversion, vascular injury, visceral injury performed to determine associated risk factors. Patient satisfaction was also evaluated. Results: The incidence of major complications was 2.1%. There was a significantly increased risk of major complications among the patients with a uterine weight of ≥500 g (7.5% vs 1.8%, P =0.002), the patients with a uterine weight of ≥400 g and pelvic endometriosis (14.3% vs 1.9%, P =0.033), or experience of surgeon <15 years (2.9% vs 1.2%, P=0.049). In total, 1,031 (94.4%) of the patients were extremely satisfied with the results of surgery. Conclusion: SiTLH technique is feasible and safe. However, the authors believe that good surgical skills and an understanding of the pelvic anatomy are essential to ensure good outcomes using our technique