A step-by-step decalogue for performing a simplified type A total laparoscopic hysterectomy using fewer accesses and tools

Hysterectomy is the most common surgical procedure performed by Gynaecologists after caesarean section. Among the Querleu and Morrow's categories, the type A hysterectomy is the proper approach not only for benignant conditions but also for certain malignant pathologies such as ovarian cancer, endometrial cancers and micro -invasive cervical cancers. The type of hysterectomy can be performed via laparoscopic hysterectomy (LH), laparoscopic-assisted vaginal hysterectomy (LAVH), robotic hysterectomy (RH) or abdominal hysterectomy (AH). The choice is based on anatomical condition, informed patient preference, and the surgeon's expertise and training. There is a common agreement to choose the most minimally invasive approach to reach the best surgical outcomes, the least operative and postoperative complications, the shortest recovery stay and the best patient fulfilment. Despite VH being the approach of choice whenever feasible, LH is a widespread surgical procedure considered the preferable alternative to AH for those patients in whom a VH is not indicated or feasible as well as a standard of care for such clinical conditions as endometrial cancer. The purpose of this decalogue is to report, step by step, type A LH using three laparoscopic accesses without the aid of uterine manipulators. This might reduce the invasiveness, the costs and the number of physicians involved, maintaining the same standard of safety.