Total Laparoscopic Hysterectomy

The benefits of total laparoscopic hysterectomy (TLH) over total abdominal hysterectomy (TAH) and laparoscopic-assisted vaginal hysterectomy (LAVH) include significantly reduced blood loss, reduced risk of surgical injuries, shorter recuperation than TAH, less pain and earlier ambulating, and lower cost. In TLH the round and infundibulopelvic ligaments were divided, the bladder reflection was created, and the uterine vessels were isolated and secured. A circumferential colpotomy was performed, and it and the peritoneal reflection were closed laparoscopically after vaginal delivery of the uterus. A special uterine manipulator used in all procedures aided in anatomic definition and performing the circumferential colpotomy. In over 250 TLH procedures the estimated blood loss and operating room time decreased due to the technique and increased surgeon experience.