No one can argue that the ultimate treatment of abnormal uterine bleeding is hysterectomy. Since the first laparoscopic hysterectomy was reported by Reich et al. 1 in 1989, the laparoscopic approach was meant to replace total abdominal hysterectomy whenever possible, not vaginal hysterectomy. However, as will be discussed later in this chapter, quality of life data now exist giving credence to performing a laparoscopic hysterectomy instead of total vaginal hysterectomy. 2
Munro and Parker have classified laparoscopic hysterectomy into four different categories. 3 In this chapter, type III laparoscopic hysterectomy, i.e. total laparoscopic hysterectomy, is discussed. In the total laparoscopic hysterectomy, the entire procedure is performed via the laparoscope. This includes treatment of ancillary pathology prior to the initiation of the hysterectomy, ureterolysis as necessary, detachment of the uterus from its ligamentous support structure, securing the vascularity to the uterus, mobilization of the bladder off the cervix, and amputation of the cervix and uterus from the vagina. Ultimately, the specimen is removed via the vagina, and the cuff repaired laparoscopically, or the cuff repaired via the laparoscope prior to morcellation of the uterus and cervix if the uterus is too large to be delivered into the vagina.