Objective: To demonstrate ergonomic-friendly surgical approach that aims to ease the physical workload of laparoscopists for total laparoscopic hysterectomy and compare surgical outcomes between ergonomic-friendly total laparoscopic hysterectomy (EF-TLH) and conventional total laparoscopic hysterectomy for preinvasive uterine disease. Methods: As the field of minimally invasive surgery grows, laparoscopists are exposed to risk of developing musculoskeletal disease due to increase in physical workload. The repetitive motion injuries occur when surgeons remain static position or improperly positioned while performing surgery. We sought to minimize physical burden to laparoscopists while performing total laparoscopic hysterectomy which is one of the most common gynecological surgery. Also, a retrospective review of 277 patients with pre-invasive uterine disease who underwent ergonomic-friendly total laparoscopic hysterectomy (n=150) or conventional total laparoscopic hysterectomy (n=81) between July 2013 to May 2019 (Table 1) was done. Preinvasive uterine disease included all stages of cervical intraepithelial neoplasia as well as pathologically-proven carcinoma in situ and patients with underlying benign uterine condition such as uterine myoma or adenomyosis were excluded. Results: In terms of surgical outcome of two groups, operating time was significantly shorter in EF-TLH group and estimated blood loss was much less in EF-TLH group. Post-op hemoglobin drop and transfusion during operation showed no significant difference between two groups. Conclusion: EF-TLH is efficient substitution for conventional TLH under similar circumstances with less operating time and blood loss when a hysterectomy is considered to be done while supporting optimal position of laparoscopists during surgery.