Laparoscopic suturing technique for total abdominal hysterectomy.

The objective of this report is to present the laparoscopic technique for total abdominal hysterectomy executed with no transvaginal approach, and by suturing and tying an extracorporeal sliding and an intracorporeal two-flat square knot. The hysterectomy methodology itself was adapted from classic abdominal hysterectomy and completed via laparoscopy with necessary modifications to meet laparoscopic technology standards. Following uterine extirpation, prophylactic, retroperitoneal posterior culdoplasty (the retroperitoneal layer of the uterosacral ligaments, rectal fascia, and paravaginal fascia were incorporated into the reconstructive process), and vaginal vault re-suspension were executed posteriorly, to the deep layer of the uterosacral ligaments, laterally, to the cardinal ligaments, and anteriorly, to the vesicocervical fascia. Laparoscopic total abdominal hysterectomy with posterior culdoplasty and vaginal vault suspension by suturing method appeared to be a safe and effective operation.