Introduction/Background The objective of this retrospective study was to evaluate the feasibility and safety of Total Laparoscopic Hysterectomy (TLH) without manipulator or any vaginal tube. We describe our technique step by step and present our data on intra-operative and post-operative morbidity.

Methodology Between January 2011 and January 2022 we performed 1.442 Total Laparoscopic Hysterectomies, without using any kind of uterine manipulator in women with benign indications for hysterectomy. We analyzed retrospectively perioperative and postoperative outcomes. During the operation we used bipolar forceps and Laparoscopic LigasureTM and vagina was Laparoscopically sutured with absorbable individual sutures. All operations were performed by the same surgical team.

Results The average age was 52.1 years and BMI 27.1 kg/m2, while the mean operative time was 78 min (43–168 min), the estimated blood loss was 59 mL (20–260 ml) and the mean uterine weight was 282 g (40–1880 g). There was no case of conversion to laparotomy. A blood transfusion was required for 26 patients (1.8%), while there was one case of ureteral injury and three cases where the bladder was opened and fixed laparoscopically. The average hospital stay was 1.1 days, with only 40 patients staying for two or more days. In the long term, we had 9 cases (0.6%) of vaginal vault dehiscence and one case of vaginal vault hematoma.

Conclusion A TLH without the use of a uterine manipulator is a feasible and safe procedure. While it is perhaps a more demanding procedure for young doctors, when performed by well-trained and experienced laparoscopic surgeons, the procedure entails a short operative time and a low complications rate. As such, it should be the first step in the training of young doctors for performing laparoscopic radical hysterectomies.

Disclosures All authors declare no conflict of interest