Objective: To evaluate the clinical factors associated major complications in total laparoscopic hysterectomy and to develop a score for a predictive model.

Materials and Methods: A retrospective cohort study was conducted. Reproductive women that underwent total laparoscopic hysterectomy for benign gynecological diseases at the Department of Obstetrics and Gynecology, Pranangklao Hospital between January 2009 and April 2017 were recruited. Major complications were defined by the presence of bowel injury and urological injury detected within six weeks after surgery and cases that had been converted to laparotomy. The predictive model and prediction score were developed by multivariate logistic regression analysis.

Results: Five hundred fourteen patients were enrolled, 493 had no major complications and 21 had incurred at least one of the major complications. In comparing the two groups, age was not statistically different, while BMI was statistically different (25.2±2.0 versus 27.6±1.9, respectively; p<0.001). The patients who had histories of lower abdominal surgery, had an ultrasonography finding of a maximal diameter of tumor mass greater than 5 cm, and had dense pelvic adhesion had significantly more major complications. The clinical score risk to predict major complications was developed with a ROC of 95.74%. Cut-off levels of total score at 4 and 11, which had positive likelihood ratios of 9.58 and 23.47, were selected. Each patient was then categorized as a low, moderate and high-risk case, respectively.

Conclusion: The present study demonstrated that clinical factors had high accuracy for predicting major complications of total laparoscopic hysterectomy. However, it is necessary for the model to have an external validation to provide sufficient evidence about its performance.

Keywords: Total laparoscopic hysterectomy, Major complication, Predictive score

Received 4 Jun 2018 | Revised 7 Aug 2018 | Accepted 16 Aug 2018