Design: A cohort study of prospectively collected data.

Setting: American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020.

Patients or Participants: Patients with a diagnosis of endometriosis undergoing hysterectomy.

Interventions: We compared short-term (30-day) complications, defined according to the Clavien-Dindo classification, for patients who underwent Minimally invasive TH and SCH for endometriosis.

Measurements and Main Results:

To identify the adjusted odds of postoperative complications, multivariable regression analysis, including age, race, ethnicity, BMI, medical comorbidities, ASA classification, uterine weight, concomitant procedures, and wound class, was performed. Our primary outcome was the risk of any postoperative complications according to the surgical approach.

A total of 6,772 patients were included, 326 (4.8%) underwent SCH, 6,446 (95.2%) underwent TH. The two groups were comparable, however those undergoing SCH were older (41.03 years vs. 39.30 years, p < 0.001) and less often tobacco users (13.8% vs. 19.4%, p = 0.011). Total operative time was marginally shorter in the TH group (mean 133.28 minutes vs. 140.89 minutes, p = 0.050).

The incidence of any complication within 30 days postoperatively was significantly lower in the SCH group compared to the TH group (3.7% vs. 8.5%, p = 0.002). Both minor complications (2.8% vs. 5.5%, p = 0.034) and major complications (1.5% vs. 3.7%, p = 0.045) were less frequent in the SCH group compared to the TH group.

Conclusion: Minimally invasive SCH is associated with a lower rate of short-term postoperative complications when compared to TH for patients with endometriosis. Further research is warranted to explore the factors associated with lower complication risks in SCH, and the long-term outcomes and potential for re-operation for patients undergoing hysterectomy for endometriosis.