Hybrid Hysterectomy Versus Laparoscopic and Open Approaches: A Propensity Score-Matched Comparison of Outcomes

Study objective: To evaluate the surgical outcomes of hybrid hysterectomy for enlarged uteri, compared to laparoscopic and open approaches.

Design: Matched case-control study SETTING: Tertiary-care academic medical center.

Patients: Patients who underwent hybrid hysterectomy between January 1, 2010, and December 31, 2021, were included. For comparison, a matched case-control approach was used with two propensity score-matched groups: patients who underwent laparoscopic hysterectomy and those who underwent open hysterectomy.

Interventions: Hybrid hysterectomy, laparoscopic hysterectomy, and open hysterectomy.

Measurements and main results: A total of 76 patients underwent hybrid hysterectomy for enlarged uteri that could not be removed intact through a colpotomy. Two comparison groups were identified by propensity-score matching the hybrid cohort to laparoscopic (n=3020) and open cohorts (n=340) based on the following criteria: age, BMI, uterine weight, year of surgery, surgeon type, hysterectomy subtype, and indication for the procedure. Operative time for the hybrid group (152 min) was comparable to the open group (148 min), but longer than the laparoscopic group (112 min, P<0.001). Compared to the hybrid group (with EBL of 50 ml), the open group had a significantly higher median EBL (200 ml, P<0.001), and the laparoscopy group had a significantly lower median EBL (27.5 ml, P=0.015). Median length of hospital stay for the hybrid group (1 day) was shorter than the open group (3 days, P<0.001), and longer than the laparoscopic group (0 days, P<0.001). Postoperative opioid administered to the hybrid group (55.0 MME) was significantly lower than the open group (91.9 MME, P=0.012), and significantly higher than the laparoscopic group (23.6 MME, P<0.001).

Conclusion: Our results indicate an advantage of the hybrid technique over an exclusively open approach when morcellation of the specimen is not appropriate. The hybrid approach is associated with less blood loss, shorter length of hospital stay, and decreased postoperative pain, with comparable operative time, and complication rates compared to the open approach.