Total and Subtotal Laparoscopic Hysterectomy

The first laparoscopic hysterectomy was performed in our center in November 1990. From then until March 1994 I performed 107 procedures. The indications were the same as for abdominal hysterectomy, such as abnormal uterine bleeding (fibroids, adenomyosis), endometriosis, adhesions, and ovarian cysts, and to reduce uterine mobility. Concomitant surgery included vaporization or excision of endometriosis, unilateral or bilateral salpingectomy with or without oophorectomy, adhesiolysis, Burch procedure, and lymphadenectomy. Several techniques were used, including automatic stapling, bipolar coagulation, and suture of the uterine vessels. When the pathology was limited to the corpus uteri, a subtotal hysterectomy was performed with extraction through a posterior colpotomy. The mean uterine weight was 165 g. Operating time was 135 minutes, and hospital stay was 3.2 days. Perioperative complications were one bladder injury (Burch) and two conversions for difficult hemostasis; no ureteral or bowel injury occurred. Postoperative complications were seven urinary infections, two vaginal hematomas, and one vaginal abscess. No thrombosis or embolism occurred.