Anatomic vascular considerations in uterine artery ligation at its origin during laparoscopic hysterectomies

Peters, Ann; Stuparich, Mallory; Mansuria, Suketu; Lee, Ted T.M.

doi:10.1016/j.ajog.2016.06.004

Cited by 21 publications

(22 citation statements)

References 6 publications

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“…as a technique to control blood loss and protect the ureter, even in cases with large uteri. The RPD required for this technique may also help prevent other visceral injuries by allowing full visualization and lateralization of the ureters . A randomized study of 400 patients showed shorter operative time (OT) and significantly less blood loss in patients who underwent uterine artery ligation at the origin versus the isthmo‐cervical region …”

Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

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Aim By evaluating operative outcomes relative to cost, we compared the value of minimally invasive hysterectomy approaches, including a technique discussed less often in the literature, laparoscopic retroperitoneal hysterectomy (LRH), which incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. Methods Retrospective chart review of all women (N = 2689) aged greater than or equal to 18 years who underwent hysterectomy for benign conditions from 2011 to 2013 at a high‐volume hospital in Maryland, USA. Procedures included: laparoscopic supracervical hysterectomy, robotic‐assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy, laparoscopic‐assisted vaginal hysterectomy, total vaginal hysterectomy (TVH), and LRH. Results Total vaginal hysterectomy had the highest intraoperative complication rate (9.6%; P < 0.0001) but the lowest postoperative complication rate (1.8%; P < 0.0001). Robotics had the highest postoperative complication rate (11.4%; P < 0.0001). LRH had the shortest operative time (71.2 min; P < 0.0001) and the lowest intraoperative complication rates (2.1%; P < 0.0001). LRH and TVH were the least costly (averaging $4061 and $6416, respectively), while RALH was the most costly ($9354). Taking both operative outcomes and cost into account, LRH, TVH and laparoscopic‐assisted vaginal hysterectomy yielded the highest value scores; total laparoscopic hysterectomy, RALH, and laparoscopic supracervical hysterectomy yielded the lowest. Conclusion Understanding the value of surgical interventions requires an evaluation of both operative outcomes and direct hospital costs. Using a quality‐cost framework, the LRH approach as performed by high‐volume laparoscopic specialists emerged as having the highest calculated value.

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Section: Methodsmentioning

confidence: 99%

Value‐based assessment of hysterectomy approaches

Danilyants¹,

MacKoul²,

Baxi³

et al. 2018

J of Obstet and Gynaecol

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“…[ 16 ] Best practices for these methods involve skilled surgeons and obstetricians who have detailed knowledge of pelvic artery anatomy that factors in vascular variations or distortions. [ 17 ] Uterine compression sutures were more likely to induce synechiae, persistent vaginal discharge, pyometra, endometriosis, and ischemic complications. [ 18 – 20 ] Furthermore, pelvic artery ligation may preclude subsequent embolization of the uterine artery when performed on an internal iliac artery, [ 21 ] and its success was only about 42% due to rich collateral vessels.…”

Section: Introductionmentioning

confidence: 99%

A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa–accreta

Fan

Gong²,

Wang³

et al. 2017

Medicine

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We studied the efficacy of prophylactic internal iliac artery balloon catheterization for managing severe hemorrhage caused by pernicious placenta previa.This prospective observational study was conducted in Tongji Hospital, Wuhan, China. One hundred sixty-three women past 32-week's gestation with placenta previa–accreta were recruited and managed. Women in the balloon group accepted prophylactic internal iliac artery balloon catheterization before scheduled caesarean delivery and controls had a conventional caesarean delivery. Intraoperative hemorrhage, transfusion volume, radiation dose, exposure time, complications, and neonatal outcomes were discussed.Significant differences were detected in estimated blood loss (1236.0 mL vs 1694.0 mL, P = .01), calculated blood loss (CBL) (813.8 mL vs 1395.0 mL, P < .001), CBL of placenta located anteriorly (650.5 mL vs 1196.0 mL, P = .03), and anterioposteriorly (928.3 mL vs 1680.0 mL, P = .02). Prophylactic balloon catheterization could reduce intraoperative red blood cell transfusion (728.0 mL vs 1205.0 mL, P = .01) and lessen usage of perioperative hemostatic methods. The incidence of hysterectomy was lower in balloon group. Mean radiation dose was 29.2 mGy and mean exposure time was 92.2 seconds. Neonatal outcomes and follow-up data did not have significant difference.Prophylactic internal iliac artery balloon catheterization is an effective method for managing severe hemorrhage caused by placenta previa–accreta as it reduced intraoperative blood loss, lessened perioperative hemostatic measures and intraoperative red cell transfusions, and reduce hysterectomies.

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“…Often, pelvic pathologies such as fibroids, endometriosis, adhesions from previous pelvic surgeries, or ovarian remnants can distort the anatomic relations and create technical challenges during laparoscopic hysterectomies. Retroperitoneal dissection, in order to ligate the uterine artery at its vascular origin, can circumvent these obstacles, resulting in a safer procedure (6) . Uterine artery anatomy and flow play an important role during pregnancy.…”

Section: Clinical Anatomy Of Uterine Arterymentioning

confidence: 99%

“…Uterine artery location and origin is also important in pelvic surgery. High vascular ligation of the afore-mentioned artery is a necessary step during hysterectomy, myomectomy, and other and gynecologic oncology procedures (6) . However, uterine arteries demonstrate a plethora of anatomic variation mainly concerning their origin, raising a challenge for the surgeon.…”

Section: Introductionmentioning

confidence: 99%

Anatomic variations of the Uterine Artery. Review of the literature and their clinical significance

Liapis

Tasis

Tsakotos

et al. 2020

tjod

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Uterin arterleri uterusa kan sağlayan ana damarlardır. Esas olarak, internal iliak arterin ön gövdesinden kaynaklanırlar. Uterin arterler hamilelikte postpartum kanama ve uterin fibroid yönetimi için transkateter arteriyel embolizasyon kadar önemli bir rol oynar. Bu, anatomik çeşitliliğin PubMed'in uterus arterlerinin kökeni ve klinik önemi üzerine veritabanında yapılan bir İngiliz literatürü derlemesidir. On bir çalışma uterus arterlerinin kökenini ve literatürdeki varyasyonlarını tanımlamaktadır. Altı çalışmada, uterus arteri olguların çoğunda, ayrı bir dal olarak veya alt gluteal arter ile bifürkasyon veya superior ve inferior gluteal arter ile trifurkasyon olarak internal iliak arterden çıkmaktaydı. İki çalışmada, inferior gluteal arter uterus arterinin ana kaynağı olarak ortaya çıkarken, üç çalışmada umbilikal arteri ana kaynağı olarak ortaya çıkmıştır. Internal iliak arter, uterus arterinin en yaygın vasküler orijini olarak tanımlanır. Bununla birlikte, bu derleme uterus arterleri için ana orijin damarlarının internal iliak, umbilikal ve inferior gluteal arter olduğunu vurgulamaktadır. Bununla birlikte, bu olağandışı anatomik yapı için sınıflandırma ve daha ileri araştırmalar gelecekte esastır.

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Anatomic vascular considerations in uterine artery ligation at its origin during laparoscopic hysterectomies

Cited by 21 publications

References 6 publications

Value‐based assessment of hysterectomy approaches

Value‐based assessment of hysterectomy approaches

A prospective observational study evaluating the efficacy of prophylactic internal iliac artery balloon catheterization in the management of placenta previa–accreta

Anatomic variations of the Uterine Artery. Review of the literature and their clinical significance

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