Total Laparoscopic Hysterectomy with Prior Uterine Artery Ligation at Its Origin

We compared the duration of surgery, blood loss, and complications between patients in whom both uterine arteries were ligated at the beginning of total laparoscopic hysterectomy (TLH) and patients in whom ligation was done after cornual pedicle. Using a prospective study in a gynecologic laparoscopic center, a total of 52 women who underwent TLH from June 2013 to January 2014 were assigned into two groups. In group A, uterine arteries were ligated after the cornual pedicles as done conventionally. In group B, TLH was done by ligating both uterine arteries at the beginning of the procedure. All the other pedicles were desiccated using harmonic scalpel or bipolar diathermy. Uterus with cervix was removed vaginally or by morcellation. The indication for TLH was predominantly dysfunctional uterine bleeding and myomas in both groups. In group A, the average duration of surgery was 71 minutes, when compared to 60 minutes in group B . In group A, the total blood loss was 70？mL, when compared to 43#x2009;mL in group B (P value < 0.001). There were no major complications in both groups. To conclude, prior uterine artery ligation at its origin during TLH reduces the blood loss and surgical duration as well as the complications during surgery. 1. Introduction Hysterectomy is a common gynecological procedure worldwide for benign uterine disease. Traditionally, this has been via the abdominal or vaginal routes [1]. In the present era, hysterectomies are undertaken using minimal access techniques. Total laparoscopic hysterectomy (TLH) is performed entirely by the laparoscopic route, including closure of the vaginal vault, with the uterus being removed vaginally or by morcellation [2]. Today, lap hysterectomy is a safe and feasible technique to manage benign uterine pathology as it offers minimal postoperative discomfort, shorter hospital stay, rapid convalescence, and early return to the activities of daily living [3]. Considerable technical advances in this procedure have occurred during the last few years. In our study, we have modified the steps and started with the ligation of the uterine artery at its origin from the internal iliac artery on both sides causing transient uterine ischemia as most blood enters the uterus through these vessels especially its ascending branch [4]. The hypothesis of this study proposes that, soon after occlusion, blood within the myometrium clots and the myometrium becomes hypoxic. The aim of this study was to compare conventional TLH to prior uterine artery ligation at its origin. 2. Materials and Methods It was a prospective