Method

Data were retrospectively reviewed for 410 patients who underwent elective gynaecological laparoscopy at University

Hospitals Birmingham between October 2021 and September 2022. After excluding cases involving total laparoscopic

hysterectomy and staging procedures, 225 cases were analysed. The procedures included diagnostic laparoscopy,

ovarian cystectomy, treatment of endometriosis, sterilisation, adhesiolysis, and others. Information on perioperative

blood loss, G&S utilisation, cross-matching, transfusion rates, and complications was extracted.

Results

• Blood Loss: Most cases (86%) experienced blood loss <50 mL, with 54% reporting <20 mL. Blood loss ≥100 mL

occurred in 4%. (Figure 1)

• Group & Save Utilization: G&S tests were sent for 66.22% of cases: 36.00% had 1 sample, 26.67% had 2

samples, and 3.56% had 3 samples. (Figure 2)

• Cross-Matching and Transfusion: Cross-matching was performed in 0.44% of cases (1/225), and no transfusions

were reported in this cohort. (Figure 3, 4)

• Co-Morbidities and Complications: Among G&S-tested patients:

o 1 sample: 7.41% had co-morbidities, including severe endometriosis, large ovarian cysts, or return to the theatre.

o 2 samples: 13.33% had co-morbidities such as advanced endometriosis, retroperitoneal cysts, or antibodies.

o 3 samples: 25.00% had co-morbidities, including preoperative anemia or extensive pelvic adhesions.

4%4% 6%

32%

53%

1%

0mls

<20mls

<50mls

<100 mls

90

80

70

60

50

40

30

20

10

0

76 81

60

8

0 samples 1 sample 2 samples 3 samples

1

224

Yes No

0%

100%

Yes No

Figure 1. Blood Loss

Figure 3. CrossMatch

Figure 2. Number of Group & Save samples Taken

Figure 4. Blood Transfusion

Given?

Cost Implications

The cost of a G&S test on the NHS is

approximately £27. In this study, 149

patients underwent G&S testing, resulting in

a total expenditure of approximately £4,023.

Given that no transfusions were required in

this cohort, the data suggest that routine

G&S testing may not be necessary in low-

risk cases. A more selective approach to

preoperative G&S testing, targeted toward

patients with higher surgical complexity or

co-morbidities, could result in substantial

cost savings while maintaining safety.

Conclusions

This cohort demonstrated minimal blood loss

and no transfusion requirements in elective

gynaecological laparoscopy, suggesting that

routine G&S testing may not always be

necessary in low-risk cases. However, these

findings should be interpreted with caution,

as patient safety must remain the foremost

priority. A more selective approach to G&S

testing, tailored to patient risk factors, could

potentially reduce costs without

compromising care. Future prospective

studies with larger sample sizes are

recommended to validate these findings and

guide the development of evidence-based

protocols for preoperative testing