子宫切除术是妇产科最常见的手术之一，可经腹、腹腔镜及经阴道完成。近年来，受女性患者对美容需求越来越高，兼具微创与美观优势的经脐单孔腹腔镜手术(transumbilicallaparoendoscopic single-site surgery，TU-LESS)应运而生。该术式利用脐部天然解剖特点，切口愈合后隐匿无痕，临床认可度高。但既往US-LESS子宫切除术多用于子宫体积<12孕周的患者，而对于子宫体积≥12孕周的大子宫切除，因存在操作空间狭小、视野局限等问题，手术难度陡增，然而目前尚无指南或共识指导US-LESS大子宫切除的手术。本文结合临床实践，从病例选择、术前准备、手术步骤、术中难点与对策、术后管理及并发症防治等方面，系统总结经脐单孔腹腔镜大子宫切除术的技术要点与操作经验，旨在为US-LESS在大子宫切除术中的规范化临床应用与推广提供实践参考，从而推动这一融合了微创、快速康复与卓越美容效果的术式更好地服务于患者。

Hysterectomy is one of the most common surgical procedures in obstetrics and gynecology, which can be performed via abdominal, laparoscopic and vaginal approaches. In recent years, driven by the growing aesthetic demands of female patients, transumbilical single-port laparoscopic surgery (US-LESS), which integrates the advantages of minimal invasiveness and cosmetic results, has emerged as a novel surgical modality. This surgical approach takes advantage of the natural anatomical features of the umbilicus, leading to a concealed and scarless incision after healing, and thus has achieved high clinical acceptance. However, previous US-LESS hysterectomies were mostly indicated for patients with a uterine size smaller than that of a 12-week gestation. For the hysterectomy of large uteri (uterine size ≥12 weeks of gestation), the surgical difficulty rises drastically due to problems such as limited operative space and narrow visual field. Up to now, there are no clinical guidelines or consensus statements to guide the performance of US-LESS for large uterus hysterectomy. Based on clinical practice, this article systematically summarizes the technical essentials and operative experience of transumbilical single-port laparoscopic hysterectomy for large uteri from the aspects of case selection, preoperative preparation, surgical procedures, intra-operative difficulties and corresponding solutions, postoperative management, as well as prevention and treatment of complications. The purpose is to provide practical references for the standardized clinical application and popularization of US-LESS in large uterus hysterectomy, thereby promoting this surgical modality that combines minimal invasiveness, enhanced recovery and excellent cosmetic effects to better serve patients.