Risk Factors Associated with Perineal and Vaginal Lacerations and Vaginal Removal in Total Laparoscopic Hysterectomy

Kenro Chikazawa; Ken Imai; Hiroyoshi Ko; Naoki Ichi; Masahiro Misawa; Tomoyuki Kuwata

doi:10.4103/gmit.gmit_118_21

Risk Factors Associated with Perineal and Vaginal Lacerations and Vaginal Removal in Total Laparoscopic Hysterectomy

Gynecol Minim Invasive Ther. 2022 Aug 5;11(3):150-154. doi: 10.4103/gmit.gmit_118_21. eCollection 2022 Jul-Sep.

Authors

Kenro Chikazawa¹, Ken Imai¹, Hiroyoshi Ko¹, Naoki Ichi¹, Masahiro Misawa¹, Tomoyuki Kuwata¹

Affiliation

¹ Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan.

Abstract

Objectives: This study aimed to identify risk factors associated with perineal and vaginal lacerations related to vaginal removal during total laparoscopic hysterectomy (TLH).

Materials and methods: We retrospectively assessed 134 patients who underwent TLH, of whom 44 (32.8%) had vaginal lacerations.

Results: Univariate analysis revealed that for patients with myomas and adenomyosis, gonadotropin-releasing hormone agonist use and myomas with a transverse diameter of ≥5 cm were significant risk factors, while multiparity (vaginal delivery) was a protective factor for perineal and vaginal lacerations. Moreover, multivariate analysis indicated that multiparity was the only statistically significant protective factor. For cervical intraepithelial neoplasia, endometrial cancer, and endometrial hyperplasia, only a uterine transverse diameter of ≥5 cm was a significant risk factor for perineal or vaginal lacerations.

Conclusion: For patients with large myomas, multiple vaginal delivery was a protective factor, and in patients with normal-sized uteri, a uterine transverse diameter of ≥5 cm was a risk factor for perineal or vaginal lacerations.

Keywords: Hysterectomy; laparoscopic surgery; morcellation; perineal laceration.