Obesity Does Not Increase Rates of Major Complications or Conversion in Minimally Invasive Hysterectomy

Objective: The aim of this study was to determine whether obese women undergoing minimally invasive hysterectomy are at increased risk of complications or conversions to open surgery. Design: This study was designed as a retrospective cohort study. Materials and Methods: All laparoscopic hysterectomies performed between 2008 and 2012 for benign pathology were included. The main outcomes analyzed, across the three body mass index (BMI) groups (normal, overweight, and obese), were operative time; hemoglobin drop; conversion to open hysterectomy; bleeding requiring blood transfusion; damage to the bladder, ureter, bowel, or vessels; return to the operating theater; readmission to hospital; and length of postoperative stay. Results: There were 186 women (124 laparoscopic hysterectomies, 62 laparoscopic-assisted vaginal hysterectomies). Of these women, 62 (33.3%) were obese, 77 (41.4%) were overweight, and 47 (25.3%) had normal BMIs. The rate of major complications was 11.3% (21/186), with conversion to open surgery being the most common (17/186; 9.1%). There were no significant differences in any of the main outcomes among the BMI categories-except for the duration of surgery, which was significantly longer for patients in the obese than for those in the overweight category (p = 0.015). Odds ratio analysis did not show that there were higher odds of complications or conversions in the obese group. The obese group was compared with the nonobese groups (overweight + normal BMI pooled together to form a "nonobese group" in this analysis), and the only difference was that the operative time was significantly longer (p = 0.009) in the obese group. Conclusions: The findings in this study suggest that minimally invasive hysterectomy does not increase the risk of complications or conversions, but operative time appears to be longer, in obese women.