Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration

Kale, Ahmet; Aksu, S; Terzi, Hasan; Demirayak, Gökhan; Türkay, Ünal; Şendağ, Fatih

doi:10.3109/01443615.2014.990431

Cited by 19 publications

(29 citation statements)

References 12 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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“…Many previous studies have shown that clamping the uterine arteries during laparoscopic hysterectomy results in less blood loss. [16] In one study, total blood loss in early uterine artery ligation group was found to be 10 ml less than that of the Standard-TLH group (50 vs. 60 ml). [17] The second advantage is that the location where the ureter crosses the uterine artery is clearly visible in the skeleton uterus technique.…”

Section: Discussionmentioning

confidence: 99%

The comparison of outcomes between the “skeleton uterus technique” and conventional techniques in laparoscopic hysterectomies

Orhan

Kasapoğlu

Ocakoğlu

et al. 2019

Gynecol Minim Invasive Ther

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Aim: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital. Materials and Methods: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques. Results: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups ( P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications. Conclusion: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation.

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“…In many studies, the suture ligation method in TLH may involve a prolonged surgical time because it requires a learning curve. The skill of an advanced surgeon compensates for the suture method and operation time of TLH [ 13 14 15 ]. In this study, the mean operation time was 96.9 minutes.…”

Section: Discussionmentioning

confidence: 99%

Total laparoscopic hysterectomy via suture and ligation technique

et al. 2016

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ObjectiveThe term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH.MethodsThis study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay.ResultsOf 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010.ConclusionThe classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.

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Uterine artery ligation at the beginning of total laparoscopic hysterectomy reduces total blood loss and operation duration

Cited by 19 publications

References 12 publications

Value‐based assessment of hysterectomy approaches

Value‐based assessment of hysterectomy approaches

The comparison of outcomes between the “skeleton uterus technique” and conventional techniques in laparoscopic hysterectomies

Total laparoscopic hysterectomy via suture and ligation technique

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