| Objective: Recent advances in equipment, surgical techniques and training have made total laparoscopic hysterectomy a well tolerated and efficient technique. It is increasingly adopted around the world because of the benefits to patients and surgeons. TLH has been shown to offer the advantages to patients of reducing hospital stay, reducing postoperative pain and quickening the recovery to normal activities . TLH means the entire process of removing the uterus under laparoscopy. It has not been carried out generally because of its difficult performing and the expensive instruments. To popularizing TLH,we will Sum up the operating procedures and the main points of using the monopolar and bipolar.Methods: A retrospective study of laparoscopic hysterecto- my was conducted in this setting From January 2004 to December 2007. 1100 women were subjected to TLH. The average age of the patients was 46(35-65). out of the 1100 patients ,63 had dysfunctional uterine bleeding(5.7%), 767 had uterine fibroid(69.8%),156 had adenomyosis(14.2%), 35 had cervical intraepithelial neoplasia(3.2%),79 had atypical hyperplasia of endometrium(7.1%).106 had a previous lower abdominal surgery(9.6%).117 had hydrosalpinx and endometrio- sis.Gynecologic examination: 34 cases had normal uterus,576 cases had enlarged uteruses consistenting with smaller than three months' pregnancy, 490 cases had enlarged uteruses consistenting with bigger than three months'pregnancy.2 cases had enlarged uteruses consistening with five months' pregnancy. Patients have no serious complications. The TLH was carried out using monopolar and bipolar and the amputated uterus was removed transvaginally. The vagina and the uterine artery were closed and under laparoscopy.Results: All the 1100 cases were done under laparoscopy, except 2 cases were converted to laparotomy. Of the 1100 cases who underwent TLH,124 had bilateral adnexectomy or ovarian cystectomy (11.3%).The mean operating time was 66±21min(35min~120min). the average amount blood loss was 134±118ml (10ml~760ml). the average weight of uterus was 314±169g(40g~1000g). The average time of eatting was 20±11hours. The average time of discharging was 27±9hours . The average recovery time of the bowel sound was 21±9 hours. The average time of exercising was 35±11 hours. The average hospital stay after operation was 4.5±0.7days. The average temperature was 37.8±0.5℃. No serious complications appeared. 2 patients had blood trasfusion for excessive bleeding. 2 cases were converted to laparotomy. 9 cases(0.08%) occurred hemorrhage of the vagina stump. The highest temperature of 120 cases (11%)exceeded 38.5℃.All of them recovered through expectant treatment. Conclusions: According of the data,the time of operation,b- lood loss ,complications, postoperative hospital day were related to the learning curve. Accumulating of experience is very important. Monopolar and biopolar are the most basical instruments of the electrosurgery. They are cheap and reproducible. It is safe and feasible when we get the key to apply them and follow the stable operating procedures. The time of operation,blood loss etc.were similar to the reports of using ligasure and ultrasonic scalpe. TLH using the most basical instrument appears a safe,effective and reproducible procedure. It has a set of stable operating procedures which can be mastered easily and prevalently.
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