Two uterine arterial management methods in laparoscopic hysterectomy

Abstract

Objective: The purpose of this study was to evaluate whether laparoscopic separation with coagulation of the uterine arteries and uterosacral ligaments can be used in an attempt to improve the operative procedure when hysterectomy is carried out by laparoscopic and vaginal method. Method: A prospective study was carried out in 70 women who underwent laparoscopic hysterectomy excluding total laparoscopic hysterectomy. Laparoscopic uterine arterial separation with coagulation (include laparoscopic reperitonization) was performed after laparoscopic detachment of the bladder and resection of the broad ligament (or adnexa) in 39 cases (Group 1). Uterine artery was coagulated by bipolar electrocoagulator and separated from the uterine side wall by scissors. Endoloop tie was applied to the arterial pedicle, if bleeding occurred. Uterine arterial management was performed through the vaginal route (include vaginal reperitonization) after laparoscopic procedure which was finished at the lower part of broad ligament with bladder detachment in 31 cases (Group 2). Results: The average duration of operation was 84.0 min and 101.8 min in Groups 1 and 2, respectively (p < 0.05). The average amount of bleeding was 154.8 ml and 298.4 ml in Groups 1 and 2, respectively (p < 0.05). Hemoglobin decreased in average by 0.9 g/100 ml and 1.6 g/100 ml in Groups 1 and 2, respectively (p < 0.05). Conclusion: These results demonstrate that laparoscopic management of uterine arterial pedicles after bladder detachment could reduce the duration of operation time and amount of bleeding in laparoscopic hysterectomy.