Advantages of Total Laparoscopic Hysterectomy

We compared 112 total laparoscopic hysterectomies (TLH) with 72 laparoscopic hysterectomies (LH) performed from January 1, 1995, to September 30, 1995. Patient characteristics (age, weight, parity) and indications for surgery were similar between the groups. All surgeries were performed with electrosurgery or suture ligature, or both. Average uterine weight was slightly lower with TLH (193.1 ± 96.2 g) versus LH (237.4 ± 84.5 g). Thirty-three women (29.46%) undergoing TLH had had previous pelvic surgery, versus 12 having LH (16.67%). Operating time was significantly shorter for TLH (117.6 ± 38.2 min) than LH (134.9 ± 37.4 min). Less bleeding, as indicated by decreased postoperative hemoglobin, was noted with TLH (1.3 ± 0.7 g/ml) versus LH (1.7 ± 1.1 g/ml). Fewer cases of serious complications, such as genitourinary tract damage, and less formation of granulation tissues on the vaginal cuff associated with persistent leukorrhea and postcoital bleeding occurred with TLH, probably because more precise surgery can be done under direct vision. We believe TLH can be performed more safely and quickly than LH by an experienced surgeon. A potential advantage of TLH is less postoperative infection due to less vaginal manipulation. Other advantages are the lengthening of the vagina, less postoperative prolapse of the vagina, and less enterocele development because of more precise anatomic restoration of the pelvic structures under direct visualization. Since detailed pelvic structures can be visualized, excised, and restored, TLH has all the possible benefits of subtotal hysterectomy, if any, due to the maximum preservation of supporting structures (cardinal, uterosacral ligaments) and nerve plexus, thus making subtotal hysterectomy obsolete. Further studies and long-term follow-up are required.