Human Reproduction, Vol. 16, No. 7, 1473-1478,
July 2001
© 2001 European Society of Human Reproduction and Embryology
Morbidity of 10 110 hysterectomies by type of approach
1 Department of Obstetrics and Gynecology, Turku University Hospital, FIN-20520 Turku, 2 Department of Obstetrics and Gynecology, Oulu University Hospital, P.O.Box 22, FIN-90221 Oulu, 3 Department of Obstetrics and Gynecology, Tampere University Hospital, P.O.Box 2000, Fin-33521 Tampere, 4 Department of Obstetrics and Gynecology, Helsinki City Maternity Hospital, Sofialehdonkatu 5 A, 00610 Helsinki, 5 Department of Obstetrics and Gynecology, North Carelia Central Hospital, Tikkamäentie 16, 80210 Joensuu, 6 Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O.Box 1777, FIN-70211 Kuopio, 7 Department of Obstetrics and Gynecology, Helsinki University Hospital, Haartmaninkatu 2, FIN-00290 Helsinki, Finland
BACKGROUND: Since the late 1980s, the option of laparoscopic hysterectomy has raised questions about the most suitable approach to hysterectomy. METHODS: To evaluate the influence of the type of approach, in causing or avoiding certain complaints in hysterectomies a prospective nationwide study was conducted comprising all hysterectomies for benign disease performed in Finland during 1996. The primary outcomes of interest were the operation-related morbidity, common surgical details and post-operative complications. RESULTS: A total of 10 110 hysterectomies, including 5875 abdominal, 1801 vaginal and 2434 laparoscopic operations showed a low rate of overall complications, 17.2, 23.3 and 19.0% respectively. Infections were the most common complications with incidences of 10.5, 13.0 and 9.0% in the abdominal, vaginal and laparoscopic group respectively. The most severe type of haemorrhagic events occurred in 2.1, 3.1 and 2.7% in the abdominal, vaginal and laparoscopic group respectively. Ureter injuries were predominant in laparoscopic group [relative risk (RR) 7.2 compared with abdominal] whereas bowel injuries were most common in vaginal group (RR 2.5 compared with abdominal). Surgeons who had performed >30 laparoscopic hysterectomies had a significantly lower incidence of ureter and bladder injuries (0.5 and 0.8% respectively) than those who had performed 
30 operations (2.2 and 2.0% respectively). A decreasing trend of bowel complications was also seen with increasing experience in vaginal hysterectomies. CONCLUSIONS: This large-scale observational study on hysterectomies provides novel information on operation-related morbidity of abdominal, vaginal or laparoscopic approach. The results support the importance of the experience of the surgeon in reducing severe complications, especially in laparoscopic and vaginal hysterectomies.
Key words: complication/epidemiology/gynaecology/hysterectomy/laparoscopy
8 To whom correspondence should be addressed. E-mail: juha.makinen{at}tyks.fi
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