NEW YORK (Reuters Health) – When gynecologic surgery is performed laparoscopically, the occurrence of thromboembolism is quite rare, even in patients with gynecologic malignancy, researchers report in the October issue of Obstetrics & Gynecology.

Still, they add, the risk is high enough in high-complexity cases to perhaps warrant prophylactic postoperative anticoagulation.

Dr. Pedro T. Ramirez, of The University of Texas MD Anderson Cancer Center in Houston, Texas and colleagues note that the risk of deep vein thrombosis can be as high as 40% in patients undergoing major gynecologic surgery. To estimate the incidence of venous thromboembolism after laparoscopic gynecologic surgery, the team analyzed data on such 849 patients at MD Anderson, about half of whom had a gynecologic malignancy.

There were only 6 instance (0.7%) of venous thromboembolism (VTE), diagnosed at a median of 15.5 days after operation. Gynecologic malignancy was present in 5 of the 6 cases.

Comparing the women who had a VTE to those who did not, the investigators saw no significant difference in age, tobacco use, body mass index, operative times, blood loss, or length of stay.

However, “there was a significant difference in the incidence of venous thromboembolism among patients based on the complexity of the surgical procedure,” according to the report.

Specifically, there were no postoperative VTEs in women undergoing low-complexity procedures such as diagnostic or second-look laparoscopy, and the rate was only 0.5% in cases classified as intermediate complexity. However, among high-complexity operations such as radical dissections, lymphadenectomies, splenectomies, and bowel resections, the incidence of VTE was 2.8%.

Dr. Ramirez and colleagues conclude that the overall incidence of postoperative VTE among patients undergoing gynecologic laparoscopy is low. “Furthermore, although slightly increased, the incidence of postoperative venous thromboembolism among patients with gynecologic malignancy remains low suggesting that prolonged postoperative thromboprophylaxis may not be warranted.”

However, they suggest that patients undergoing high-complexity laparoscopic procedures “may benefit from pharmacologic thromboprophylaxis with consideration of extended prophylaxis given that the median time to venous thromboembolism diagnosis among patients in the current study was 15 days.”

Obstet Gynecol 2010;116:956-961.