Retrospective evaluation of the crucial factor in total laparoscopic hysterectomy by using video review

Hiroaki Komatsu, Fuminori Taniguchi, Hiroki Nagata, Takaya Nakaso, Yohei Nagaya, Satoru Tsukihara, Masako Sarugami, Tasuku Harada, Yasunobu Kanamori


Background: Hysterectomy is commonly performed for uterine myomas, uterine cancers, and uterine prolapses. In this study, we aimed to evaluate the procedures for improving our surgical skill in total laparoscopic hysterectomy (TLH).
Methods: Retrospective video reviews of TLH surgeries for 30 patients at our hospital were performed. The operation period was divided into the four phases (phases 1, 2, 3, and 4). We divided the TLH procedures into nine consecutive steps and evaluated the critical factors to complete this surgery.
Results: Median surgical time, blood loss amount, and uterine weight were 107 min, 5 mL, and 241 g, respectively. Total surgical time in phrases 3 and 4 was significantly shorter compared with that in phase 1. Duration of surgical time positively correlated with uterine weight (P=0.0346) and blood loss amount (P=0.0001), whereas there was no significant correlation between the uterine weight and blood loss amount. In phases 3 and 4, there were no correlation between the uterine weight and the surgical time.
Conclusions: The most crucial factor for determining surgical time in our TLH procedures would be the identification of ureter and the transection of uterine artery (P<0.0001). Accurate identification of ureter and transection of uterine artery during TLH could shorten the total surgical time.