The number of laparoscopic surgeries has been increasing in regional core hospitals, and procedures involving total laparoscopic hysterectomy (TLH) are being performed more frequently. Therefore, the importance of data acquisition and analysis of TLH procedures has increased. In particular, examining the risks of complications for improving surgical procedures and patient selection is considered especially crucial in regional healthcare settings, where medical resources are relatively limited. To determine the prevalence of and risk factors associated with the occurrence of the major intraoperative complications of TLH, we performed a multivariate analysis using records from our hospital.

We retrospectively reviewed the medical records of 548 patients who underwent TLH to treat uterine diseases from 1 January 2010 to 31 December 2024. Among these patients, 27 patients were identified with major intraoperative complications, such as organ injury and massive blood loss. First, we conducted simple comparisons using Fisher’s exact test (two-tailed) for 22 representative factors related to patient characteristics. Then, we performed a multivariate logistic regression analysis to assess the effects of nine representative factors, including both preoperative and intraoperative/postoperative factors.

According to the results of the Fisher’s exact test (two-tailed) and multivariate analysis, we detected significant impacts of (1) high body mass index (BMI) (defined as 30 kg/m² or greater), (2) hypermenorrhea, and (3) coexistent ovarian endometriotic cysts among the preoperative factors and (1) high BMI (defined as 30 kg/m² or greater), (2) hypermenorrhea, (3) intraoperative findings of adhesions, and (4) heavy uterine weight (500 g or greater) among the intraoperative/postoperative factors.

This study identified certain trends in risk factors associated with major intraoperative complications of TLH, using a relatively simple analysis. These findings may provide important information when TLH is considered a surgical option. Based on these findings, future studies with more sophisticated methodologies will be necessary to provide additional insights.