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Objective: We aimed to confirm the safety of total laparoscopic hysterectomy (TLH). We compared surgical morbidity in laparoscopically-assisted vaginal hysterectomy (LAVH), laparoscopic hysterectomy (LH), and TLH in the treatment of benign gynecologic diseases. Methods: We conducted a retrospective study and evaluated 69 patients who underwent LAVH (n=34), LH (n=12), or TLH (n=23) between January 2014 and April 2016 at Otsu Municipal Hospital. LH and TLH were performed with the Koh colpotomizer system. TLH was performed with ligation of the uterine artery and identification of the ureter. The results were examined statistically according to patient age, nulliparity rate, body mass index, median uterine weight, postoperative C-reactive protein level, operative complications, operative blood loss, and operative time. Results: Median age, nulliparity rate, median body mass index, median uterine weight, median postoperative C-reactive protein level, and operative complications showed no significant differences among the three groups (P>0.05). While the median operative time in the TLH group was longer (LAVH: 198, LH: 184.5, TLH: 220.0 min, P>0.05), there were no statistically significant differences among the three groups. The median intraoperative blood loss in the TLH group was significantly less than that in the LAVH group (LAVH: 245.5, LH: 107.5, TLH: 50.0 ml, P<0.01). Conclusions: TLH with use of the Koh colpotomizer system, ligation of the uterine artery, and identification of the ureter were useful and safe operative methods

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Comparison of three laparoscopic hysterectomy procedures: A retrospective study of laparoscopically-assisted vaginal hysterectomy, laparoscopic hysterectomy, and total laparoscopic hysterectomy