Senior Residents' Training Program for Safe Total Laparoscopic Hysterectomy

Total laparoscopic hysterectomy (TLH) is the standard treatment for benign gynecological diseases. We introduced a senior residents' training program to equip these clinicians with skills to perform safe TLH. Residents developed their own training box and trained themselves. We evaluated residents' progress with technical skills and compared the training methods at least once a month. As part of their training, residents performed laparoscopic surgery in a sequential manner as follows: ovarian cystectomy and salpingo-oophorectomy, followed by surgery for complicated endometriosis to learn the operative strategy in such cases, and finally TLH. TLH involved the insertion of a ureteral stent and uterine manipulator with a colpotomy cup to secure an optimal field of view and to prevent ureteral complications. Ureters were freed from the retroperitoneum. and were closely observed intraoperatively. The uterine artery was cauterized and cut only in close proximity to the manipulator cup. Residents could reconfirm the surgical steps of an abdominal hysterectomy because the operative method used to perform an abdominal hysterectomy was the same as that used for TLH. The aforementioned sequential approach and use of specific equipment helped residents to develop surgical skills to perform safe TLH.