OBJECTIVES: To compare the Vcare and SecuFix uterine manipulators (UM) used in total laparoscopic hysterectomy (TLH) with regard to operating time, duration of hospital stay, the time for insertion of the manipulator, time for completion of colpotomy, and maintenance of pneumoperitoneum, estimated blood loss, and perioperative complications. MATERIAL AND METHODS: This prospective, single-center, randomized controlled trial was conducted on patients who underwent TLH for benign indications between June 2023 and January 2024. Patients were randomized to either the Vcare UM or SecuFix UM group. Both groups were compared for operative time, colpotomy time, intrauterine manipulator insertion time, pneumoperitoneum maintenance, blood loss, complications, and length of hospital stay. RESULTS: A total of 100 patients were enrolled, 50 with VcareUM and 50 with SecuFix UM. SecuFix UM demonstrated shorter colpotomy time (p <
0.001) and better pneumoperitoneum maintenance (p = 0.008) compared to VCare. VCare had shorter insertion time (p = 0.001) but a higher uterine rupture rate (p = 0.001). No significant differences were found in operative time, blood loss, complications, or length of hospital stay (p >
0.05). CONCLUSIONS: SecuFix may offer advantages in colpotomy and pneumoperitoneum maintenance during TLH compared to VCare. The Vcare UM demonstrated a shorter insertion time than the SecuFix UMs, yet a higher rate of uterine rupture was observed with its placement.