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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. 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. 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). 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.

It is considered that establishing accredited specialized centers can serve as a marketing tool. This study investigated whether accredited specialized centers influence patients’ choice of hospital. A total of 2,389 patients was included in a questionnaire survey: 468 at the Department of Gynecology, 745 at the certified University Breast Center of Franconia, 1,000 at the University Perinatal Center of Franconia and 176 for whom classification details were lacking. Among the oncological patients, physicians in private practice played an important role in the choice of hospital (58.4 vs. 25.7%; P