Lampé Rudolf, Margitai Nóra, Török Péter, Lukács Luca, Orosz Mónika
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary.
Diagnostics (Basel). 2025 Jul 8;15(14):1736. doi: 10.3390/diagnostics15141736.
Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. The mean operative time was 67.2 ± 18.4 min, and the mean uterine weight was 211.9 ± 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 ± 0.9 g/dL. Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted.
全腹腔镜子宫切除术（TLH）被广泛认为是治疗良性妇科疾病的首选微创技术。然而，文献中关于手术顺序仍存在显著异质性，特别是在子宫动脉结扎、输尿管识别和阴道断端闭合等步骤上。这种缺乏标准化的情况可能会影响并发症发生率、手术培训的可重复性以及手术效率。本研究的目的是制定并评估一种标准化的、基于解剖学原理的TLH手术方案，该方案主要为培训目的而设计，但适用于大多数临床病例。这项回顾性观察性研究分析了2016年1月至2020年7月期间在一家三级医疗中心接受TLH手术的109例患者。所有病例均采用固定的手术步骤顺序，强调在子宫动脉起始处尽早结扎、在输尿管上方打开阔韧带以及腹腔镜“8”字缝合法闭合阴道断端。提取并分析了患者的人口统计学数据、手术数据和围手术期结果。平均手术时间为67.2±18.4分钟，平均子宫重量为211.9±95.3克。3.7%的病例出现术中并发症，包括1.8%的膀胱损伤和1.8%的小肠损伤，所有这些均通过腹腔镜处理，无需中转开腹。1.8%的患者出现阴道断端裂开，3.7%的患者出现术后阴道出血。1例患者（0.9%）因阴道断端血肿/脓肿需要再次手术。未报告需要干预的术后感染。术后第一天血红蛋白平均下降1.2±0.9克/分升。我们的研究结果支持基于解剖标志和早期血管控制的结构化TLH方案的可行性、可重复性和安全性。广泛采用类似方案可能会提高一致性和培训效果，在常规手术实践中具有广泛适用性，并有可能适用于严重复杂的病例；然而，需要在多中心研究中进行进一步验证。
