Total laparoscopic hysterectomy

We analyzed our experience with laparoscopic hysterectomy and determined the most important factors that made it safe and reproducible. From January 1, 1994, to March 30, 1996, 68 laparoscopic hysterectomies were performed. The most frequent indication was uterine myomas. Average operating time decreased over the years from 6 hours in 1994 to 1.5 hours in 1996. The most important reasons for the long surgery time were surgeons' skills, uterine size, posterior wall leiomyomata, presence of adhesions, history of cesarean section, presence of deep infiltrating endometriosis with obliteration of the cul-de-sac, and equipment failure. We had no major intraoperative complications, except for a bladder injury in a woman who had had two cesarean sections, which was diagnosed and immediately repaired laparoscopically. Continuous training in endoscopic surgery, especially learning how to dissect the pelvic organs, the development of a trained team, adequate equipment, and appropriate patient selection were among the most important factors that allowed us to reach a safe level in performing this procedure.