Temporary Ligation of the Uterine Artery at Its Origin Using a Removable “Shoelace” Knot

Abstract

To demonstrate a technique of temporary ligation of the uterine artery at its origin. Design: A step-by-step demonstration of the surgery in an instructional video. Setting: A private hospital in Mumbai, India. Intervention: The peritoneum over the pelvic side wall was dissected bilaterally to expose the uterine arteries at their origins. Using a polyglactin absorbable suture, a double thread loop was used to create a removable "shoelace" knot (Video 1). Both uterine arteries were ligated in this manner. The myomectomy was completed uneventfully, and the myoma bed was sutured in 2 layers using polyglactin sutures. Once suturing was completed, the shoelace knot was untied by simply pulling one end of the thread to restore blood supply to the uterus. Intraoperative blood loss was 30 mL, and the total operation time was 120 minutes. Conclusion: Laparoscopic ligation of the uterine arteries at their origin is known to reduce intraoperative blood loss [1,2]. However, in patients desiring future fertility, the effect of permanent ligation of these vessels bilaterally remains under study [3−5]. The removable "shoelace" knot is a low-cost, readily available alternative to metallic titanium clips that requires no special surgical expertise to implement.

The effect of temporary uterine artery ligation on laparoscopic myomectomy to reduce intraoperative blood loss: A retrospective case–control study

“…However, titanium clips are not designed for removal after insertion, and the removal procedure might cause additional problems, such as vessel injury [12] , [13] , [14] , [15] . Recently, temporary uterine artery ligation has been introduced to solve these problems [22] , [23] . Temporary uterine artery ligation has the advantage of being less invasive and can be introduced at any facility with a technique equivalent to uterine artery identification at total laparoscopic hysterectomy without special equipment.…”