Hysterectomy, removal of the uterus, is the second most common major operation among women in the United States. Approximately 600,000 hysterectomies are performed yearly in the United States at a cost of nearly $5 billion, according to the Centers for Disease Control and Prevention.

While studies indicate that many hysterectomies can safely and successfully be performed using laparoscopic techniques, the majority of these surgeries are performed abdominally through an “open” laparotomy incision. Despite laparoscopic surgery’s advantages in appropriately selected patients – less postsurgical pain, quicker recovery times and smaller scars — OB/GYN’s have lagged behind other fields in adopting this minimally-invasive approach.

There is a great need for scientifically-validated, advanced surgical simulation training that will assist practicing OB/GYN’s in the transfer of surgical skills from the “open” abdominal hysterectomy approach to the laparoscopic approach, as well as train residents and fellows in the latest techniques for laparoscopic hysterectomy.

The following training curriculum for Total Laparoscopic Hysterectomy provides repetitive practice of surgical skills required for the Total Laparoscopic Hysterectomy procedure, in a safe and reproducible environment.

The course is intended for practicing OB-GYN surgeons, as well as residents and fellows, who are familiar with basic laparoscopic skills and gynecological procedures. Refer to ‘Basic Laparoscopic Gynecology Skills and Procedures Course’ for comprehensive basic skills and basic gynecological procedure training.

Prior to participating in the hysterectomy course, the participant should demonstrate a minimal skill level for two basic laparoscopic tasks in the basic course referenced above. The required skill levels are derived from the Development of a Virtual Reality Training Curriculum for Laparoscopic Cholecystectomy (Darzi et al. British Journal of Surgery 2009; 96: 1086–1093).

In the second course component the participant performs a total laparoscopic hysterectomy procedure using the LAP Mentor simulator. Participants train in the key components of the procedure: Uterine manipulation, superior pedicle division, bladder mobilization, exposure and division of the uterine vessels and performance of a colpotomy. The course of the ureters may be visualized transperitoneally, or through a retroperitoneal dissection. Either salpingo-oophorectomy or preservation of the adnexa may be performed.

Included in this curriculum are a variety of complications and emergency situations that may occur during the key steps of the procedure including: Ureteral injuries, injury to the bladder or bowel and uterine artery bleeding. The simulation also provides the surgeon with flexibility to determine the extent of bladder mobilization, identification of the course of the ureters, and recognition of the cervico-vaginal margin during colpotomy. All the key decision points of the actual procedure are incorporated into a realistic surgical environment. The curriculum provides a complete educational solution, including videos of individual steps of the real procedure, step-by-step procedural guidance and comprehensive objective performance metrics.

  • Demonstrate a basic skill level, using two simulated laparoscopic tasks, as determined in: Development of a Virtual Reality Training Curriculum for Laparoscopic Cholecystectomy (Darzi et al. British Journal of Surgery 2009).
  • Safely perform an advanced gynecological procedure, Total Laparoscopic Hysterectomy, in a simulated environment.


Target Audience

Practicing OB-GYN physicians, as well as residents and fellows, who are interested in hands-on simulation-based training for a Total Laparoscopic Hysterectomy procedure.

  • Familiarity with basic laparoscopic skills and basic gynecological procedures.
  • Participants are required to demonstrate a basic skill level, on two simulated laparoscopic tasks.
Suggested Time Length

Suitable for 2 day training courses or for distributed training.


This course was written in collaboration with:

Larry R Glazerman MD, MBA, FACOG. Associate Professor and Director, Minimally Invasive Gyn Surgery. Co-Director, USF Center for the Advancement of Minimally-Invasive Pelvic Surgery University of South Florida College of Medicine.

Stuart Hart, MD, FACOG, FACS. Assistant Professor,Division of Female Pelvic Medicine and Reconstructive Surgery. Department of Obstetrics and Gynecology. Co-Director, USF Center for the Advancement of Minimally-Invasive Pelvic Surgery. Medical Director, Tampa Bay Research and Innovation Center (TBRIC). University of South Florida College of Medicine.