Gastrointestinal and vascular damage during total laparoscopic hysterectomy: A review of the literature

Katsakos I, Karpeta M, Paraskevaidis C, Papadis P, Paparistidis N

2nd Department of Obstetrics and Gynecology, Elena Venizelou hospital, 2 Elena Venizelou Square, GR-11521 Athens, Greece

Correspondence: Katsakos Ioannis, 11 Agiou Georgiou St, GR-15451 Athens, Greece. E-mail:


The following review examines the current role and complication rates of total laparoscopic hysterectomy (TLH), which is a hysterectomy completed entirely laparoscopically. Recent advances in equipment, surgical techniques and training have established total laparoscopic hysterectomy as a well tolerated and efficient technique. It is increasingly being adopted around the world because of the benefits to patients and surgeons. This study discusses the complications of TLH especially in gastrointestinal and vascular system, compares different surgical approaches to hysterectomy and provides suggestions on ways to avoid possible complications. Total laparoscopic hysterectomy is an attractive, safe, feasible and reproducible surgical procedure for the management of benign gynaecological conditions and many researchers recommend its use on a larger scale. The overall risk of complications is small and the rates of major complications are not greater than for abdominal procedures. The risk of ureteral injury seems to be slightly increased during TLH and is most commonly associated with laparoscopic ligation of uterine arteries, especially if the surgeon is unskilled in such a procedure. This risk, however, should not prevent TLH from being used more widely. On the other side, the probability of gastrointestinal or vascular damage seems to be the same as in open surgery. Total laparoscopic hysterectomy is not inherently dangerous but some of the surgeons who perform it lack expertise or experience. Evidence-based studies support the use of vaginal hysterectomy (VH), if possible, over laparoscopic (LH) and abdominal (AH) hysterectomies. They also support a laparoscopic approach to hysterectomy over total abdominal hysterectomy (TAH). As more surgeons become trained in advanced laparoscopic surgery, total laparoscopic hysterectomy will increasingly take over the role of total abdominal hysterectomy. Advanced laparoscopic training and supervision are paramount to minimize complications.

Keywords: complications, laparoscopic hysterectomy, abdominal hysterectomy, vaginal hysterectomy

p. 95-104