Laparoscopic-assisted vaginal hysterectomy with uterine artery ligation through retrograde umbilical ligament tracking
Journal
Journal of Minimally Invasive Gynecology
Journal Volume
12
Journal Issue
4
Pages
336-342
Date Issued
2005
Author(s)
Huang S.-C.
Hsu W.-C.
Abstract
STUDY OBJECTIVE: To evaluate the clinical outcomes of uterine artery ligation through retrograde tracking of the umbilical ligament (RUL) in laparoscopic-assisted vaginal hysterectomy (LAVH). DESIGN: Prospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Two hundred twenty-five women with myomas or adenomyosis. INTERVENTION: Laparoscopic-assisted vaginal hysterectomy with uterine artery identification and ligation through RUL. MEASUREMENTS AND MAIN RESULTS: The 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 × operation time + 0.48 × 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. CONCLUSION: Minimal 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. ? 2005 AAGL. All rights reserved.
SDGs
Other Subjects
pethidine; adenomyosis; adult; artery ligation; article; bleeding; blood transfusion; cesarean section; clinical article; comparative study; endometriosis; female; hospitalization; human; laparoscopic surgery; ligament; linear regression analysis; myoma; operation duration; outcomes research; prospective study; regression analysis; uterine artery; uterus weight; vaginal hysterectomy; Adult; Aged; Arteries; Blood Loss, Surgical; Endometriosis; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyoma; Length of Stay; Ligation; Middle Aged; Organ Size; Prospective Studies; Regression Analysis; Uterine Diseases; Uterine Neoplasms; Uterus
Type
journal article