Aim

By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy, which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin.

Methods

Retrospective chart review of all women (N = 2,689) >18 years old who underwent hysterectomy for benign conditions from 2011 through 2013 at a high-volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotically-assisted laparoscopic hysterectomy, total laparoscopic hysterectomy, laparoscopically-assisted vaginal hysterectomy, total vaginal hysterectomy, and laparoscopic retroperitoneal hysterectomy.

Results

Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; p <.0001) but lowest postoperative complication rate (1.8%; p <.0001). Robotics had the highest postoperative complication rate (11.4%; p <.0001). Laparoscopic retroperitoneal hysterectomy had the shortest operative time (71.2 min; p <.0001) and lowest intraoperative complication rates (2.1%; p <.0001). Taking both operative outcomes and cost into account, laparoscopic retroperitoneal hysterectomy, total vaginal hysterectomy, and laparoscopically-assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, robotically-assisted laparoscopic hysterectomy, and laparoscopic supracervical hysterectomy yielded the lowest.

Conclusion

Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality-cost framework, the laparoscopic retroperitoneal hysterectomy technique emerged as having the highest calculated value.