Total laparoscopic hysterectomy: indications, techniques and outcomes

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures

Background:

• Hysterectomy is a common gynecologic procedure.
• Laparoscopic and vaginal approaches offer potential benefits over abdominal hysterectomy.

Purpose of the Study:

• To review indications, techniques, and outcomes of laparoscopic hysterectomy, particularly total laparoscopic hysterectomy (TLH).
• To assess the evolution and current applicability of TLH techniques.

Main Methods:

• Review of existing literature and techniques for laparoscopic and total laparoscopic hysterectomy.
• Analysis of evidence-based studies comparing different hysterectomy approaches.

Main Results:

• The original TLH technique remains applicable and effective, with a low risk of ureteral injury.
• Evidence supports vaginal hysterectomy over laparoscopic and abdominal routes, and laparoscopic over abdominal hysterectomy.
• Expansion of TLH techniques has occurred in gynecologic oncology.

Conclusions:

• Gynecologic surgical specialists have been slow to adopt evidence-based laparoscopic and vaginal hysterectomy techniques.
• Despite proven benefits, the adoption rate of laparoscopic hysterectomy, in general, has been notably slow.
• Future trends may see increased utilization of these minimally invasive approaches.