Current evidence on the safety and efficacy of laparoscopic techniques for hysterectomy (including laparoscopically assisted vaginal hysterectomy [LAVH], laparoscopic hysterectomy [LH], laparoscopic supracervical hysterectomy [LSH] and total laparoscopic hysterectomy [TLH]) appears adequate to support their use, provided that normal arrangements are in place for consent, audit and clinical governance.
Clinicians should advise women that there is a higher risk of urinary tract injury and of severe bleeding associated with these procedures, in comparison with open surgery.
Advanced laparoscopic skills are required for these procedures, and clinicians should undergo special training and mentorship. The Royal College of Obstetricians and Gynaecologists (RCOG) has developed an Advanced Training Skills Module, Benign gynaecological surgery: laparoscopy. This would need to be supplemented by further training in order to achieve the skills required for total laparoscopic hysterectomy.