IRB did not approve this study.

This randomized trial is aimed to investigate the role of retroperitoneal TLH in enlarge uterus.

Laparoscopic hysterectomy is one of the most common gynecologic surgeries worldwide. Generally, in total laparoscopic hysterectomy (TLH), uterine arteries are coagulated or transected close to the uterus, alongside the cervix, like surgical technique of a conventional total abdominal hysterectomy. Recently, several studies showed that ligation of uterine artery where it originates from the internal iliac artery during TLH (so-called "retroperitoneal TLH") is effective for reducing blood loss. However, the application of this technique to clinical practice have not been well investigated in terms of its efficacy and safety. Moreover, most of the previous studies on retroperitoneal TLH were small case series or retrospective comparative studies with conventional TLH. Therefore, the investigators conducted this randomized trial to investigate the role of retroperitoneal TLH in enlarge uterus.

Inclusion Criteria:

• absence of pregnancy at the time of presentation
• uterine volume between 12 and 18 weeks of gestation by pelvic examination
• appropriate medical status for laparoscopic surgery (American Society of Anesthesiologists Physical Status classification 1 or 2)

Exclusion Criteria:

• any suggestion of malignant uterine or adnexal diseases
• any major medical comorbidities or psychiatric illnesses, which could affect follow-up and/or compliance
• an inability to understand and provide written informed consent.