A review of total laparoscopic hysterectomy: role, techniques and complications

PURPOSE OF REVIEW: The following review examines the current role of total laparoscopic hysterectomy, which is a hysterectomy completed entirely laparoscopically. Recent advances in equipment, surgical techniques and training have made total laparoscopic hysterectomy a well tolerated and efficient technique. It is increasingly being adopted around the world because of the benefits to patients and surgeons. This study discusses the role of total laparoscopic hysterectomy, provides some technical suggestions about how to perform a total laparoscopic hysterectomy and how to avoid possible complications. RECENT FINDINGS: Only a few surgeons performing total laparoscopic hysterectomy have published their techniques and results. The terminology and techniques for total laparoscopic hysterectomy used by different surgeons, such as energy sources, the use of uterine manipulators, vaginal tubes, the method for uterine artery ligation and method of vault closure, vary. This makes objective comparison of the literature, techniques and complication rates difficult. SUMMARY: As more surgeons become trained in advanced laparoscopic surgery, the role of total laparoscopic hysterectomy will increasingly take over indications for total abdominal hysterectomy. It remains important that surgeons share their experience and publish their techniques, results and complications. Advanced laparoscopic training and supervision are paramount before embarking on total laparoscopic hysterectomy, so that complications are minimized.