title: Total laparoscopic hysterectomy via suture and ligation technique.
abstract: OBJECTIVE
  The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH.
  
  
  METHODS
  This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay.
  
  
  RESULTS
  Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010.
  
  
  CONCLUSIONS
  The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.
authors: Department of Obstetrics and Gynecology, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors: Hye Won
authors: HW
authors: Kang
authors: Department of Obstetrics and Gynecology, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors: Ji Won
authors: JW
authors: Lee
authors: Department of Obstetrics and Gynecology, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors: Ho Yeon
authors: HY
authors: Kim
authors: Department of Obstetrics and Gynecology, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors: Bo Wook
authors: BW
authors: Kim
authors: Department of Obstetrics and Gynecology, Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
authors: Chong Soo
authors: 0000-0003-4980-4424
authors: CS
authors: Moon
keywords: Classical suture; Hysterectomy; Laparoscopy