Laparoscopic-assisted vaginal hysterectomy with uterine artery ligation through retrograde umbilical ligament tracking

Chang WC, Wen‐Chun Chang, Wen-Chun Chang, Pao‐Ling Torng, Pao-Ling Torng, Su-Cheng Huang, Su‐Cheng Huang, Huang Sc, Bor-Ching Sheu, Bor‐Ching Sheu, Wen-Chiung Hsu, Hsu WC, Ruey‐Jien Chen, Ruey-Jien Chen, Chow SN, Song-Nan Chow, Song‐Nan Chow, Daw‐Yuan Chang, Chang DY, Daw-Yuan Chang
Journal of Minimally Invasive Gynecology · 2005 · vol. 12(4) , pp. 336–342 · doi:10.1016/j.jmig.2005.05.006 · PMID:16036194 · W1996667747
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This paper describes a novel laparoscopic technique for hysterectomy, utilizing retrograde umbilical ligament tracking to ligate the uterine arteries, which was performed successfully in a case study.

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Abstract

Study objectiveTo evaluate the clinical outcomes of uterine artery ligation through retrograde tracking of the umbilical ligament (RUL) in laparoscopic-assisted vaginal hysterectomy (LAVH).DesignProspective study (Canadian Task Force classification II-3).SettingUniversity-affiliated hospital.PatientsTwo hundred twenty-five women with myomas or adenomyosis.InterventionLaparoscopic-assisted vaginal hysterectomy with uterine artery identification and ligation through RUL.Measurements and main resultsThe median age of the patients was 46 years, and the median weight of the extirpated uteri was 340 g, with 26.2% of uteri weighing more than 500 g. The median operation time was 135 minutes, and the median blood loss was 50 mL. The median intramuscular meperidine requirements were 1 ampoule (50 mg), and the median hospital stay was 3 days. It took approximately 10 minutes from identification of the umbilical ligament to ligation of the uterine artery. Uterine weight of 500 g or more required a significantly longer operation time compared with uteri weighing less than 500 g (164 min vs 127 min median, p <.001), and there was more blood loss (100 mL vs 50 mL median, p <.001). There were no differences in the median intramuscular meperidine requirements or hospital stay between the two groups. No blood transfusion was needed in either group, even in patients with a uterine weight of more than 1000 g. By regression analysis, uterine weight was significantly related to blood loss and operation time. A linear relationship was found among uterine weight, operation time, and blood loss: Uterine weight = 87.589 + 1.881 x operation time + 0.48 x blood loss (R = 0.531, F = 35.694, degrees of freedom 184, p <.001). No complications related to RUL were observed, although two bladder injuries related to severe pelvic adhesion with endometriosis and previous cesarean section occurred.ConclusionMinimal blood loss and a low complication rate were noted in LAVH by uterine artery ligation through RUL. This technique should be a valid approach, especially in patients in whom minimal blood loss must be achieved.

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Condition tags

endometriosis

MeSH descriptors

Hysterectomy, Vaginal Uterus Adult Aged Arteries Arteries Blood Loss, Surgical Blood Loss, Surgical Blood Loss, Surgical Endometriosis Endometriosis Female Humans Hysterectomy, Vaginal Laparoscopy Leiomyoma Leiomyoma Length of Stay Ligation Middle Aged

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License: CC0 · commercial use OK