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The uterus was taken out of the abdomen from the vaginal cuff. Before this, the laparoscopic equipment was removed from the abdominal space, and insufflation was stopped. When necessary, a manual morcellation was carried out vaginally (circular wedge resection of the uterus by scalpel).

Objective The aim of this study was to evaluate the complication rate after laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LASH) in case of benign disease. Design All complications were prospectively recorded at the time of surgery and analysed retrospectively. Setting University hospital.

Population Among 4505 hysterectomies performed by the same team using the same techniques between 1990 and 2006, 3190 were performed by laparoscopy, 906 by the vaginal route and 409 by laparotomy. Methods Laparoscopic hysterectomies, defined as laparoscopic subtotal hysterectomy (LASH) and total laparoscopic hysterectomy [laparoscopy‐assisted vaginal hysterectomy (LAVH) switched to total laparoscopic hysterectomy (TLH) in 2000], were compared with vaginal and abdominal hysterectomies. Main outcome measures and results Since the early 1990s, the number of laparoscopic procedures has continued to grow, while the number of abdominal and vaginal procedures has decreased. Both minor complications (fever >38.5°C after 2 days, bladder incision of. Introduction Laparoscopy is now widely recognised as an indispensable tool in gynaecologic surgery. The first hysterectomy performed by laparoscopy was described by Reich et al.

In the following years, Mage et al., Donnez and Nisolle and Lyons, respectively, described their first series of laparoscopy‐assisted vaginal hysterectomy (LAVH) and laparoscopic subtotal hysterectomy (LASH). Surgical advantages to laparoscopy are related to the magnification provided in the pelvis, facilitating access to the uterine vessels, ureter, rectum and vagina.

Patient advantages are also multiple and are related to the avoidance of a painful abdominal incision. They include shorter hospitalisation and recuperation time and an extremely low rate of infection and ileus. Indications for laparoscopic hysterectomy include numerous benign pathologies, but it may also be considered for endometrial cancer. - Laparoscopic hysterectomy has been associated with high rates of complications, particularly in terms of urinary tract injuries, compared with abdominal hysterectomy (OR 2.61, 95% CI 1.22–5.60).

- Having encountered major complication rates as high as 11.1 and 9.8% with laparoscopic hysterectomy, Johnson et al., and Garry et al. Concluded that vaginal hysterectomy should be considered the technique of choice; only if vaginal hysterectomy is not possible, should laparoscopic hysterectomy be proposed to avoid abdominal hysterectomy. However, Karaman et al. And Bojahr et al. Concluded that laparoscopic hysterectomy is a safe, reproducible technique associated with a low complication rate (between 0 and 1.4%), especially with respect to urinary tract injuries. We report a series of 4505 hysterectomies [LASH, total laparoscopic hysterectomy (TLH) and vaginal and abdominal hysterectomy] for benign disease performed in our department between 1990 and 2006. The aim of this study was to evaluate the complication rates between laparoscopic, vaginal and abdominal hysterectomy.

Incidence (%) of laparoscopic, vaginal and abdominal procedures in a series of 4505 hysterectomies for benign disease. Our uterine volume limit for laparoscopic hysterectomy was equivalent to 16–17 weeks of gestation, unless gonadotrophin‐releasing hormone (GnRH) agonist was used preoperatively to decrease the size of the uterus. Hysterectomies for malignant disease, such as endometrial cancer, cervical cancer and ovarian cancer, were not included in the study.

Duration of surgery was not statistically analysed because of great variation resulting from the training of fellows and residents; it would not have been truly representative. Of the 4505 operations, 3190 procedures (70.8%) were laparoscopic. Other procedures were vaginal hysterectomy (20.1%, n = 906) and abdominal hysterectomy (9.1%, n = 409). All the operations were performed by the same team using the same reproducible techniques. A total of six surgeons, assisted by residents in training, performed all of these procedures. During surgery, all complications were recorded.

Any remarkable events occurring in the course of the operation, as well as immediate postoperative evolution, were noted in the hospital database. All women were reviewed after 4–6 weeks.

Data on all surgical procedures were subsequently collected from the hospital database. Surgical procedures listed as abdominal hysterectomy, vaginal hysterectomy, LASH and laparoscopic hysterectomy were included in the study. They were reviewed in detail, and perioperative complications, correction and follow up were noted.