{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:18:32Z","timestamp":1790651912372,"version":"4.1.0"},"reference-count":22,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Total laparoscopic hysterectomy (TLH) is widely accepted as the preferred minimally invasive technique for the treatment of benign gynecologic conditions. However, significant heterogeneity persists in the literature regarding the operative sequence, particularly for steps such as uterine artery ligation, ureteral identification, and vaginal cuff closure. This lack of standardization may affect complication rates, reproducibility in surgical training, and procedural efficiency. The objective of this study was to develop and evaluate a standardized, anatomically justified surgical protocol for TLH primarily designed for training purposes but applicable to most clinical cases. Methods: This retrospective observational study analyzed 109 patients who underwent TLH between January 2016 and July 2020 at a single tertiary care center. A fixed sequence of surgical steps was applied in all cases, emphasizing early uterine artery ligation at its origin, broad ligament fenestration above the ureter, and laparoscopic figure-of-eight vaginal cuff closure. Patient demographics, operative data, and perioperative outcomes were extracted and analyzed. Results: The mean operative time was 67.2 \u00b1 18.4 min, and the mean uterine weight was 211.9 \u00b1 95.3 g. Intraoperative complications were observed in 3.7% of cases and included bladder injury in 1.8% and small bowel injury in 1.8%, all of which were managed laparoscopically without conversion. Vaginal cuff dehiscence occurred in 1.8%, and postoperative vaginal bleeding in 3.7% of patients. One patient (0.9%) required reoperation due to a vaginal cuff hematoma\/abscess. No postoperative infections requiring intervention were reported. The mean hemoglobin drop on the first postoperative day was 1.2 \u00b1 0.9 g\/dL. Conclusions: Our findings support the feasibility, reproducibility, and safety of a structured TLH protocol based on anatomical landmarks and early vascular control. Widespread adoption of similar protocols may improve consistency and training, with broad applicability in routine surgical practice and potential adaptation in severely complex cases; however, further validation in multicenter studies is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics15141736","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T11:58:07Z","timestamp":1751975887000},"page":"1736","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Stepwise Anatomy-Based Protocol for Total Laparoscopic Hysterectomy: Educational Tool with Broad Clinical Utility"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8230-7692","authenticated-orcid":false,"given":"Rudolf","family":"Lamp\u00e9","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u00f3ra","family":"Margitai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e9ter","family":"T\u00f6r\u00f6k","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Luk\u00e1cs","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nika","family":"Orosz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, 98 Nagyerdei krt., 4032 Debrecen, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2996","DOI":"10.1093\/humrep\/14.12.2996","article-title":"Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy: Assessment of the Learning Curve","volume":"14","author":"Perino","year":"1999","journal-title":"Hum. 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