The most difficult step in single site total laparoscopic hysterectomy is cuff closure.  This occurs because of the inherent narrow manipulation angle forcing all ‘straight stick’ instruments into parallel.  Techniques employing single handed suturing or the use of the Endostitch device have made laparoscopic cuff closure possible but each has it’s own limitations.

We present here the learning curve for cuff closure as well as a novel approach to laparoscopic suturing using a vertical closure technique.