A Stepwise Anatomy-Based Protocol for Total Laparoscopic Hysterectomy: Educational Tool with Broad Clinical Utility

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Surgical Standardization
• Laparoscopic Procedures

Background:

• Total laparoscopic hysterectomy (TLH) is a standard minimally invasive treatment for benign gynecologic conditions.
• Current literature shows significant variation in TLH operative steps, impacting outcomes and training.
• A standardized protocol is needed to improve efficiency, safety, and reproducibility.

Purpose of the Study:

• To develop and evaluate a standardized, anatomically justified surgical protocol for TLH.
• The protocol is designed for surgical training and broad clinical applicability.
• Focus on early uterine artery ligation, ureteral identification, and vaginal cuff closure.

Main Methods:

• Retrospective observational study of 109 patients undergoing TLH.
• Application of a fixed surgical sequence emphasizing anatomical landmarks and early vascular control.
• Analysis of patient demographics, operative data, and perioperative outcomes.

Main Results:

• Mean operative time: 67.2 ± 18.4 min; Mean uterine weight: 211.9 ± 95.3 g.
• Low complication rates: 3.7% intraoperative (bladder/bowel injury), 1.8% vaginal cuff dehiscence, 3.7% postoperative bleeding.
• High safety profile with minimal reoperations (0.9%) and no reported infections requiring intervention.

Conclusions:

• A structured TLH protocol based on anatomical landmarks and early vascular control is feasible, reproducible, and safe.
• Widespread adoption can enhance surgical consistency and training effectiveness.
• Further multicenter validation is recommended for broader application, including complex cases.