Aims:  To examine perioperative outcomes after total laparoscopic hysterectomy compared with fast‐track open hysterectomy using a retrospective case–control study.
Methods:  Consecutive cases of total laparoscopic hysterectomy (TLH) carried out by a single surgeon were matched with cases of fast‐track open hysterectomy (FTOH) carried out by a second surgeon. Women were matched for age, body mass index, European Cooperative Oncology Group performance status, benign or malignant disease and extent of surgery.
Results:  Fifty women were included in each group; women undergoing TLH had a shorter hospital inpatient length of stay (LOS) (1.82 vs 2.62 days, P = 0.02), but longer total theatre time (TT) and surgical time (ST) (226 vs 182 min, P = 0.05; 172 vs 137 min, P = 0.04). LOS, TT and OT were shorter in the second 25 women undergoing TLH than the first 25 cases (1.8 days vs 2.6 days (P = 0.02); 137 min vs 173 min (P = 0.04); 200 min vs 226 min (P = 0.05). A comparison of the second 25 women undergoing TLH with the matched cohort undergoing FTOH revealed a shorter LOS, but no difference in TT or ST (1.8 days vs 3.4 days (P < 0.001); 175 min vs 200 min (P = 0.33); 137 min vs 144 min (P = 0.48)). There were no readmissions in the TLH group and two in the FTOH group, one for a wound infection and another for a small bowel obstruction. Conclusion:  A TLH results in significantly shorter inpatient stay than FTOH and after an initial learning curve does not result in prolonged theatre or surgical times.