Total laparoscopic hysterectomy: a 5-year experience

  • Christopher Chee Mun Ng
  • Bernard Su Min Chern
Original Article



To evaluate our surgical technique with regards to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus by analysing its intra-operative and post-operative outcomes and complications in the hope of reducing their occurrence.


Retrospective study based on TLH operations performed from January 2001 to December 2005. The KOH Colpotomizer™ System and the RUMI Uterine Manipulator® were used.


Five hundred and twelve women consented for TLH. Five hundred and three women (98.2%) had successful TLH with three mini-laparotomy and six laparotomy conversions (1.8% failure rate). Mean uterine size was 11 cm (5–17). Mean operating time was 133 min (40–257). Mean blood loss was 309 ml (50–1,500). Twenty patients (4%) required blood transfusion (five excessive bleeding). Injuries include bowel injury (5), bladder (2), uterine perforation (1), ureterovaginal fistula (1) and vaginal laceration (5). Post-operative complications include pyrexia (36), umbilical wound infection (5), urinary tract infection (UTI) (4) and vault haematoma (3). Mean hospital stay was 2.7 days (1–10). Eighteen patients (3.6%) were readmitted for vaginal bleeding (10), vault haematoma (2), UTI (1), anxiety (3), giddiness (1) and ureterovaginal fistula (1). Twenty-three women (4.5%) encountered major complications (laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage ≥1,000 ml, ureteric injury, bowel injury and pulmonary embolus) which compares favourably with other centres (4–11%). Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are comparable.


TLH with adequate training is associated with low morbidity, few complications and a high success rate.


Laparoscopy Hysterectomy Intra-operative Post-operative Complications 



We would like to thank Ms Chia Yit Ching (Nurse Co-ordinator, Minimally Invasive Unit, KKH, Singapore) for her invaluable assistance in data analysis.


  1. 1.
    Reich H, Decaprio J, McGlynn F (1989) Laparoscopic hysterectomy. J Gynaecol Surg 5:213–216CrossRefGoogle Scholar
  2. 2.
    Richardson RE, Bournas N, Magos AL (1995) Is laparoscopic hysterectomy a waste of time? Lancet 345:36–41PubMedCrossRefGoogle Scholar
  3. 3.
    Garry R, Hercz P (1995) Initial experience with laparoscopic assisted Dorderlein hysterectomy. Br J Obstet Gynaecol 102:307–310PubMedGoogle Scholar
  4. 4.
    O’Shea RT, Petrucco O, Gordon S, Seman EI (2000) Adelaide laparoscopic hysterectomy audit (1991–1998): realistic complication rates! Gynaecol Endosc 9(6):369–372CrossRefGoogle Scholar
  5. 5.
    O’Shea RT, Gordon SJ, Seman EI, Verco CJ (2000) Total laparoscopic tube hysterectomy: a safer option? Gynaecol Endosc 9(5):285–291CrossRefGoogle Scholar
  6. 6.
    O’Shea RT, Cook JR, Seman EI (2002)Total laparoscopic hysterectomy: a new option for removal of the large myomatous uterus. Aust N Z J Obstet Gynaecol 42(3):282–284PubMedCrossRefGoogle Scholar
  7. 7.
    Garry R, Reich H, Liu CY (1994) Laparoscopic hysterectomy–definitions and indications. Gynaecol Endosc 3:1–3Google Scholar
  8. 8.
    National Health and Medical Research Council (2003) When does quality assurance in health care require independent ethical review? Aust N Z J Obstet Gynaecol 43:189CrossRefGoogle Scholar
  9. 9.
    Koh CH (1998) A technique and system for simplifying total laparoscopic hysterectomy. J Am Assoc Gynaecol Laparosc 5(2):187–192CrossRefGoogle Scholar
  10. 10.
    Seman EI, O’Shea RT, Gordon S, Miller J (2001) Routine cystoscopy after laparoscopically assisted hysterectomy: what’s the point? Gynaecol Endosc 10(4):253–256CrossRefGoogle Scholar
  11. 11.
    Chou DCY, Rosen DMB, Cario GM, Carlton MA, Lam AM, Chapman M, Johns C (1999) Home within 24 h of laparoscopic hysterectomy. Aust N Z Obstet Gynaecol 39(2):234Google Scholar
  12. 12.
    Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R (2005) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 1:CD003677 (review)PubMedGoogle Scholar
  13. 13.
    Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R (2005) Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ 330:1478PubMedCrossRefGoogle Scholar
  14. 14.
    Ellström M, Ferraz-Nunes J, Hahlin M, Olsson JH (1998) A randomized trial with a cost-consequence analysis after laparoscopic and abdominal hysterectomy. Obstet Gynecol 91(1):30–34PubMedCrossRefGoogle Scholar
  15. 15.
    Garry R, Founatin J, Mason S, Hawe J, Napp V, Abbott J, et al (2004) The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328:129–138PubMedCrossRefGoogle Scholar
  16. 16.
    Garry R, Phillips G (1995) How safe is the laparoscopic approach to hysterectomy? Gynaecol Endosc 4:77–79Google Scholar
  17. 17.
    Häkki-Sirén P, Sjoberg J, Makinen J (1997) Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations. Am J Obstet Gynaecol 176:118–122CrossRefGoogle Scholar
  18. 18.
    Cook JR, O’Shea RT, Seman EI (2004) Laparovaginal hysterectomy: a decade of evolution. Aust N Z J Obstet Gynaecol 44:111–116PubMedCrossRefGoogle Scholar
  19. 19.
    Elkington NM, Chou D (2006) A review of total laparoscopic hysterectomy: role, techniques and complications. Curr Opin Obstet Gynecol 18(4):380–384PubMedCrossRefGoogle Scholar
  20. 20.
    Nuemann M, Eidelman A, Langer R, Golan A, Bukovsky I, Caspi E (1991) Iatrogenic injuries to the ureter during gynecologic and obstetric operations. Surg Gynecol Obstet 173:268–272Google Scholar
  21. 21.
    Harris WJ, Daniell JF (1996) Early complications of laparoscopic hysterectomy. Obstet Gynecol Surv 51:559–567PubMedCrossRefGoogle Scholar
  22. 22.
    Tsaltas J, Lawrence A, Michael M, Pearce S (2002) complications of laparoscopic hysterectomy: the Monash experience. Aust N Z J Obstet Gynaecol 42(3):295–299PubMedCrossRefGoogle Scholar
  23. 23.
    David-Montefiore, Rouzier R, Chapron C, Darai E (2007) Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 22(1):260–265PubMedCrossRefGoogle Scholar
  24. 24.
    Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Seally MJ, Peterson MB (1982) Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The collaborative review of sterilization. Am J Obstet Gynecol 144:841–848PubMedGoogle Scholar
  25. 25.
    Wattiez A, Soriano D, Cohen SB, Nervo P, Canis M, Botchorishvili R, Mage G, Pouly JL, Mile P, Bruhat MA (2002) The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J AM Assoc Gynecol Laparosc 9(3):339–345PubMedCrossRefGoogle Scholar
  26. 26.
    Chapron C, Dubuisson JB, Ansquer Y, Fernandez B (1998) Hystérectomie totale pour pathologies bénignes La coeliochirurgie ne semble pas majorer le risque de complications. J Gynecol Obstet Biol Reprod 27:55–61Google Scholar
  27. 27.
    Gary R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, Clayton R, Phillips G, Whittakr M, Lilford R, Bridgman S, Brown J (2004) The eVALuate study: two parallel randomized trails, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 328(7432):129CrossRefGoogle Scholar
  28. 28.
    Lyons T (1995) Laparoscopic approaches to pelvic floor support. Gynaecol Endosc 4:81–82Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Christopher Chee Mun Ng
    • 1
  • Bernard Su Min Chern
    • 2
  1. 1.General Obstetrics and GynaecologyKK HospitalSingaporeSingapore
  2. 2.Minimally Invasive Surgery DepartmentKK HospitalSingaporeSingapore

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