To study if separating the vaginal and abdominal surgical fields during total laparoscopic hysterectomy (TLH) is associated with surgical site infection (SSI) rates.

Design:

A retrospective cohort study of all patients who underwent TLH and any concomitant procedures with two minimally invasive gynecologic surgery (MIGS) subspecialists from 1/2016 through 5/2023.

Setting:

Conventional TLHs.

Patients or Participants:

A total of 680 patients, of which 377 (55.4%) underwent TLH by Surgeon 1 and 303 (44.6%) by Surgeon 2.

Interventions:

Preoperative antibiotic prophylaxis was administered per formal guidelines. All patients underwent perineal-vaginal preparation and separate abdominal preparation. Surgeon 1 performed surgeries with surgical field separation, which included glove changes of the top gloves when crossing fields, while Surgeon 2 performed surgeries without changes. The two surgeons had access to the same operating rooms, staff, trainees, anesthesiology group and instruments sterilization process.

Measurements and Main Results:

Data was collected from the electronic medical record. We assessed characteristics and outcomes of patients who underwent TLH with Surgeon 1 and Surgeon 2. The primary outcome was the occurrence of any postoperative infection within 30 days of surgery.

The overall SSI rate was 1.0%. The occurrence of any infection was 0.8% (3/377) for Surgeon 1 vs. 1.3% [4/303, OR 95% CI 0.60 (0.13-2.70)] for Surgeon 2, including superficial incisional, deep incisional, organ/space, and urinary tract infections.

All patients who had SSIs also received antibiotic prophylaxis during surgery. The occurrence of readmission, reoperation or vaginal cuff dehiscence was also low in both groups.

Conclusion:

The infection rate after TLH is low with or without surgical field separation, and our overall infection rate fell on the lower end of the reported range. Additional information on the need for surgical field separation is important because most emissions created by the healthcare system come from single-use items in the supply chain.