For a study, researchers wanted to compare the surgical results of complete laparoscopic hysterectomy with total vaginal hysterectomy in patients with uterine weights larger than 250 g. They used data from the American College of Surgeons’ National Quality Improvement Project Hysterectomy Specific Database to perform a retrospective cohort research. Women with uterine weights more than 250 g who had a hysterectomy for benign causes either complete laparoscopic hysterectomy or total vaginal hysterectomy were matched using propensity scores generated based on preoperative features and uterine weight. Total vaginal hysterectomy was matched 1:1 to total laparoscopic hysterectomy. Wilcoxon rank-sum and Fisher exact tests were used as needed for pairwise analysis. To determine the independent effect of complete vaginal hysterectomy on surgical outcomes, multivariable logistic regression was used. 

There were 1,870 vaginal hysterectomies and 3,740 laparoscopic hysterectomies in total. There were no changes in the patients’ preoperative demographics or comorbidities. Uterine weight was comparable in both groups: 376 g (interquartile range 293–501) for complete vaginal hysterectomy and 384 g (interquartile range 302–515) for total laparoscopic hysterectomy (OR 0.98, 95% CI 0.92–1.09). Total vaginal hysterectomy and total laparoscopic hysterectomy had comparable rates of composite significant complications (4.3% vs 5.3%, OR 0.80, 95% CI 0.61–1.05). Complete vaginal hysterectomy resulted in more intraoperative cystotomies (0.8% vs 0.3%, OR 2.74, 95% CI 1.17–6.61), while total laparoscopic hysterectomy resulted in more ureteral injuries (1.2% vs 0.2%, OR 0.12, 95% CI 0.02–0.38). The operating time for complete vaginal hysterectomy was considerably shorter than for total laparoscopic hysterectomy (77 minutes, interquartile range 56–111 vs 122 minutes, interquartile range 91–164; OR 0.69, 95% CI 0.42–0.89). After controlling for covariates, complete vaginal hysterectomy was shown to be related to a decreased risk of significant morbidity (aOR 0.95, 95% CI 0.18–5.11) and a lower risk of operating times surpassing 2.5 hours (aOR 0.31, 95% CI 0.27–0.43).

Total vaginal hysterectomy was not related to an elevated composite risk of significant surgical morbidity or other poor surgical outcomes in individuals matched by uterus size and preoperative characteristics.