Objective: The purpose of this study was to determine the causes of massive blood loss during total laparoscopic hysterectomy (TLH).
Methods: A retrospective case study analysis of 453 patients who underwent TLH between April 2010 and April 2014 in our hospital was performed. Clinical characteristics of those with intraoperative blood loss more than 500 mL (group A) and those with less than 500 mL (group B) were compared. Furthermore, the mean intraoperative blood loss was compared between the group with cervical fibroma and that with fibroma at other sites, the group with complicated endometriosis and that without, and the group with history of abdominal surgery and that without. The surgical video records of each case in group A were carefully reviewed to find specific causes of massive bleeding.
Results: Intraoperative blood loss volume of 500 mL or more was present in only 10 patients (2.2%). Complication with endometriosis and a history of abdominal surgery were significantly more common in group A than in group B. No significant difference in mean surgical blood loss was observed by fibroma site (cervical vs other). Review of the videos revealed that massive blood loss occurred due to multiple reasons in some cases.
Conclusion: These results suggested that the complications of endometriosis, history of abdominal surgery, and their combination might induce massive blood loss during the TLH procedure.
