• Malin Brunes, Ulrika Johannesson, Henrike Häbel, Marie Westergren Söderberg, and Marion Ek.
• Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet (Drs. Brunes, Söderberg, and Ek), Stockholm, Sweden; Division of Obstetrics and Gynecology, Södersjukhuset (Drs. Brunes, Söderberg, and Ek), Stockholm, Sweden. Electronic address: malin.brunes@sll.se.
• J Minim Invasive Gynecol. 2021 Feb 1; 28 (2): 228-236.

Study ObjectiveTo assess if women with obesity have increased complication rates compared with women with normal weight undergoing hysterectomy for benign reasons and if the mode of hysterectomy affects the outcomes.DesignCohort study.SettingProspectively collected data from 3 Swedish population-based registers.PatientsWomen undergoing a total hysterectomy for benign indications in Sweden between January 1, 2015, and December 31, 2017. The patients were grouped according to the World Health Organization's classification of obesity.InterventionsIntraoperative and postoperative data were retrieved from the surgical register up to 1 year after the hysterectomy. Different modes of hysterectomy in patients with obesity were compared, such as open abdominal hysterectomy (AH), traditional laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and robot-assisted laparoscopic hysterectomy (RTLH).Measurements And Main ResultsOut of 12,386 women who had a total hysterectomy during the study period, we identified 2787 women with normal weight and 1535 women with obesity (body mass index ≥30). One year after the hysterectomy, the frequency of complications was higher in women with obesity than in women with normal weight (adjusted odds ratio [aOR]) 1.4; 95% confidence interval [CI], 1.1-1.8). In women with obesity, AH was associated with a higher overall complication rate (aOR 1.8; 95% CI, 1.2-2.6) and VH had a slightly higher risk of intraoperative complications (aOR 4.4; 95% CI, 1.2-15.8), both in comparison with RTLH. Women with obesity had a higher rate of conversion to AH with conventional minimally invasive hysterectomy (TLH: aOR 28.2; 95% CI, 6.4-124.7 and VH: 17.1; 95% CI, 3.5-83.8, respectively) compared with RTLH. AH, TLH, and VH were associated with a higher risk of blood loss >500 mL than RTLH (aOR 11.8; 95% CI, 3.4-40.5; aOR 8.5; 95% CI, 2.5-29.5; and aOR 5.8; 95% CI, 1.5-22.8, respectively) in women with obesity.ConclusionThe use of RTLH may lower the risk of conversion rates and intraoperative bleeding in women who are obese compared with other modes of hysterectomy.Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.

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