Total laparoscopic hysterectomy (THL) is an operation that involves almost every skill needed for LSCP. Spend some more attention and time on some specific steps of the procedure in order to prepare you for LSCP. Dissection of the bladder is very similar to the anterior dissection during LSCP and appears as an excellent training. Try to dissect the bladder low enough to see the bare white vaginal wall over a length of 3 or 4 cm and try to localize the ureters laterally. Posterior dissection may also be a good training if you open the peritoneum between the vagina and the rectum before cutting the uterosacral ligaments. You will see the rectovaginal space opening under the pressure of the CO₂ and the white posterior wall of the vagina will be visible over a couple of centimeters. Spotting the ureters on the pelvic sidewalls is also a very useful exercise, especially in overweighed patients, in which the fatty tissue is frequently hiding these structures, forcing you to open the peritoneum and dissect the extra peritoneal space to localize them. In the end, suturing the vaginal cuff is another useful exercise to your laparoscopic skills. Try to do it in different ways: extra peritoneal knots, intra peritoneal knots, running sutures. Mastering THL is crucial; the learning curve takes 30–50 patients. Then you can start to plan your first LSCP.

Of course, for surgeons that are not gynecologists and who don’t perform hysterectomies, this step doesn’t exist and they’ll have to move directly towards step 3.

It is very important to see the technique performed by trained surgeons who do it as a routine. And watching videos is insufficient to learn because on a video, that usually lasts about 10–20 min, only successful gestures are shown. No difficulty or issue appears on the film. It is crucial to see complete procedures to become able to face any situation. Many national or international meetings program live surgery sessions in which the operation is commented by a moderator and questions may be asked. Another way to see live operations is to be invited into the OR by a trained colleague and, if you’re lucky, to assist him during the operation. This is even better than live sessions during congresses because you can see how the OR is organized. You see all the instruments, how they are handled by the surgeon and by the nurses. The information shared is more intimate and you will be more likely to learn some tips and tricks that the surgeon has made up to simplify the operation. It also establishes links that may help you further to start a kind of mentorship that is very useful to start LSCP. The ideal mentorship would be to go to the mentor and watch a couple of LSCP performed by him, then to schedule two LSCP in your own OP and to invite your mentor. He performs the first LSCP with you as an assistant and you perform the second with him assisting you. It is certainly difficult to organize but, in our experience, it is the best way to start quickly and safely.