Feasibility and Safety of Outpatient Total

Background and Objective: Ambulatory total laparo-scopic hysterectomy (TLH) could lead to significant cost savings, but some fear the effects of what could be pre-mature postsurgical discharge. We sought to estimate the feasibility and safety of TLH as an outpatient procedure for benign gynecologic conditions. Methods: We report a prospective, consecutive case se-ries of 128 outpatient TLHs performed for benign gyne-cologic conditions in a tertiary care center. Results: Of the 295 women scheduled for a TLH, 151 (51%) were attempted as an outpatient procedure. A total of 128 women (85%) were actually discharged home the day of their surgery. The most common reasons for ad-mission the same day were urinary retention (19%) and nausea (15%). Indications for hysterectomy were mainly leiomyomas (62%), menorrhagia (24%), and pelvic pain (9%). Endometriosis and adhesions were found in 23% and 25 % of the cases, respectively. Mean estimated blood loss was 56 mL and mean uterus weight was 215 g, with the heaviest uterus weighing 841 g. Unplanned consulta-tion and readmission were infrequent, occurring in 3.1% and 0.8 % of cases, respectively, in the first 72 hours. At 3 months, unplanned consultation, complication, and read-mission had occurred in a similar proportion of inpatient and outpatient TLHs (17.2%, 12.5%, and 4.7 % versus 18.1%, 12.7%, and 5.4%, respectively). In a logistic regres-sion model, uterus weight, presence of adhesions or en-dometriosis, and duration of the operation were not asso-ciated with adverse outcomes. Conclusion: Same-day discharge is a feasible and safe option for carefully selected patients who undergo an uncomplicated TLH, even in the presence of leiomyomas, severe adhesions, or endometriosis.