Background
Total laparoscopic hysterectomy (TLH) is established as a safe method of hysterectomy, with a satisfactory patient experience. However, most published data derive from high‐volume centres with experienced teams. It is not clear whether these data translate to smaller centres?

Aims
To evaluate the implementation of a minimally invasive option for hysterectomy at a regional public hospital in New Zealand.

Materials and methods
Prospective audit of 120 cases of TLH over three years. We retrospectively compared outcomes to the same number of abdominal (AH) and vaginal hysterectomy (VH).

Results
TLH and AH were predominantly performed for heavy menstrual bleeding (65 and 64%) and VH for prolapse (54%). The largest uteri were AH (range 30–3400 g), TLH (35–550) then VH (21–256). Compared to TLH, both AH and VH had shorter mean operating theatre times (TLH 126.8 ± 44.8 min, AH 103.2 ± 32.8 and VH 93 ± 26.9), longer mean hospital stay (TLH 51.3 ± 21.3 h, AH 101.9 ± 36.6 and VH 75.1 ± 31.3) and increased mean blood loss (TLH 153 ± 116.1 mL, AH 517 ± 672.3 and VH 244 ± 206.8). One TLH was converted to laparotomy and one required interval laparoscopy. Major complications (2.5%) were lowest in the TLH group and were consistent with large international series.

Conclusions
TLH would appear to be a safe and effective local option. The outcomes for patients at a regional general hospital can replicate the results of larger centres.