title: The Hohl instrument for optimizing total laparoscopic hysterectomy: results of more than 500 procedures in a university training center.
abstract: OBJECTIVE
  To evaluate complication rates associated with total laparoscopic hysterectomy (TLH) using the Hohl instrument in women with benign indications for hysterectomy, a prospective cohort study was conducted in a university teaching hospital.
  
  
  METHODS
  A total of 567 women with benign indications for hysterectomy underwent the TLH procedure using the Hohl instrument between January 2005 and July 2009. The laparoscopic approach was used when the patient had undergone more than one previous pelvic abdominal operation, when an adnexal finding was present, and/or if the patient had reduced vaginal capacity.
  
  
  RESULTS
  One ureteral injury (0.18%), four bladder injuries (0.71%), one small-bowel injury (0.18%), one vaginal injury (0.18%), and one conversion to abdominal hysterectomy (0.18%) occurred. The general complication rate during surgery was 1.42%, whereas in the postoperative period was 3.19%. The mean loss of hemoglobin was 1.47 g/dL (SD 1.06), the mean operating time was 103.87 min (SD 43.89), and the mean uterus weight was 241.41 g (SD 196.73).
  
  
  CONCLUSIONS
  Total laparoscopic hysterectomy using the Hohl instrument simplifies the surgical procedure. The technique reported here is safe and effective in preventing ureteral complications during TLH, even in a university training program.
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, Universitätsstrasse 21-23, 91054, Erlangen, Germany. andreas.mueller@uk-erlangen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Mueller
authors.forename: Alexander
authors.initials: A
authors.lastname: Boosz
authors.forename: Martin
authors.initials: M
authors.lastname: Koch
authors.forename: Sebastian
authors.initials: S
authors.lastname: Jud
authors.forename: Florian
authors.initials: F
authors.lastname: Faschingbauer
authors.forename: Michael
authors.initials: M
authors.lastname: Schrauder
authors.forename: Christian
authors.initials: C
authors.lastname: Löhberg
authors.forename: Grit
authors.initials: G
authors.lastname: Mehlhorn
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Renner
authors.forename: Michael P
authors.initials: MP
authors.lastname: Lux
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Falk C
authors.initials: FC
authors.lastname: Thiel
mesh_terms: D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology