Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis

Abstract

We tried to evaluate the relative feasibility, surgical duration and complications of total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries at their origin (CUA) plus total laparoscopic hysterectomy for the management of myoma and adenomyosis, and to compare the estimated blood loss for both procedures. A total of 123 patients underwent TLH or CUA plus TLH for the treatment of symptomatic myoma and adenomyosis. Sixty-four women underwent TLH, whilst 68 women underwent coagulation of uterine arteries at their origin plus TLH. The mean weight and volume of the uterus as determined following TLH was 288.1+/-102.4 gm (range 182.1 approximately 396.2 gm.) and 451+/-340.6 cm(3) (range 107.4 approximately 792), respectively. The mean weight of the uterus following CUA plus TLH was 269.1+/-151.7 gm (range 215.8 approximately 430.1) whilst the mean uterine volume was 472.7+/-377.8 cm(3) (range 93.7 approximately 851.2). No significant differences with respect to surgical duration (95 vs. 96.5 minutes TLH vs. CUA + TLH; p>0.05), blood loss (177.2+/-80.1 ml for TLH and 154.9+/-30.21 ml for CUA+TLH; p>0.05) and mean+/-SD preoperative (12.05+/-1.70 gm/dl for TLH and 12.14+/-1.38 gm/dl for CUA+TLH; p>0.05) and post-operative hemoglobin level (11+/-1.03 for TLH and 11+/-1.49 for CUA + TLH; p>0.05) were observed between the two study groups. The blood loss for TLH is comparable to that for the CUA plus TLH procedure.

Retroperitoneal and Retrograde Total Laparoscopic Hysterectomy – Technique with Three- and Five-millimeter Trocars

“…The rate of urologic complications observed in our experience may be justified by the absence of selection of the patients except for uterine size and is in agreement to that reported by similar studies using retroperitoneal approach [8][9][10][20][21][22].…”

Uterine artery closure at the origin vs at the uterus level in total laparoscopic hysterectomy: A randomized controlled trial

“…13 The low number of included patients, the subjective assessment of outcomes, and an inadequate follow up limited results interpretations. [10][11][12] One trial was further confounded by using a two-step approach. 12 In this scenario, our randomized, single-blind controlled trial provides robust evidence of a reduced intraoperative blood loss with the UA closure at the origin, which appears independent from the uterus weight, confirming a small but consistent benefit regardless of the uterine size.…”

“…13 Three randomized controlled trials investigated the UA closure at the origin, providing conflicting results and not reaching definitive conclusions. [10][11][12] In a recent meta-analysis, significant heterogeneity in intraoperative blood loss and postoperative hemoglobin drop were observed, with only intraoperative blood loss reported with a statistically significant reduction. 13 The low number of included patients, the subjective assessment of outcomes, and an inadequate follow up limited results interpretations.…”

“…Nevertheless, despite the strong interest in reducing intraoperative bleeding, limited evidence is available regarding the technical aspects concerning UA management during a TLH 13 . Three randomized controlled trials investigated the UA closure at the origin, providing conflicting results and not reaching definitive conclusions 10–12 . In a recent meta‐analysis, significant heterogeneity in intraoperative blood loss and postoperative hemoglobin drop were observed, with only intraoperative blood loss reported with a statistically significant reduction 13 .…”

“…Three randomized controlled trials tried to answer this question. [10][11][12] However, they provided heterogeneous results and did not reach definitive conclusions. A recent meta-analysis focusing on strategies to minimize blood loss during hysterectomies stressed the presence of low-quality evidence on this specific issue and the need for further investigation.…”