الفهرس 
OVERVIEW OF HYSTERECTOMYOnly 14 pages are availabe for public view
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Abstract
T
he primary objective of this study was to evaluate the effectiveness of uterine artery clipping at the outset of Total Laparoscopic Hysterectomy (TLH) in reducing intraoperative blood loss.
To achieve this, a randomized controlled trial was conducted on women experiencing abnormal vaginal bleeding refractory to medical treatment, with diagnoses of either fibroid uterus or adenomyosis.
A total of forty-two eligible participants, who provided informed consent, were randomly assigned to undergo TLH either conventional TLH (group A) or with uterine artery clipping (group B).
In group A (conventional TLH), the surgical procedure followed established guidelines described by Rocks and John (2015) which included advanced bipolar diathermy for ligament coagulation, broad ligament opening to expose uterine vessels, and the creation of a bladder flap. The uterine vessels were coagulated using LigaSur™, followed by vaginal wall incision and subsequent removal of the uterus via the vaginal route. The vault was closed laparoscopically, and port site incisions were sutured.
In group B (TLH with uterine artery clipping), uterine artery clipping was performed before TLH. The surgical procedure followed established guidelines described by Uaccela (2021). The uterine artery was accessed through a medial approach, and its origin from the internal iliac artery was identified. Temporary suspension of both ovaries facilitated exposure for uterine artery clipping. The procedure continued similarly to conventional TLH, with uterine vessels being clipped at their origin from the hypogastric vessels.Once completed, the ovaries were returned to their normal position.
The study assessed various outcomes, with a primary focus on blood loss during surgery, and secondary outcomes severe bleeding, re-exploration, intra-operative and postoperative complications, and total operative time. Demographic factors such as age, BMI, parity, and gestational age did not exhibit significant differences between the two groups.
Operative time, however, showed a statistically significant difference, with the study group (TLH with uterine artery clipping) having a longer mean operative time of 72.76±7.05 minutes compared to the control group (conventional TLH) with a mean operative time of 63.76±6.28 minutes.
Postoperative hemoglobin, hematocrit, and hematocrit DROP did not significantly differ between the groups. Although the mean estimated blood loss (EBL) was slightly higher in the control group (173.86±119.32 ml) compared to the study group (130.75±113.69 ml), this difference was not statistically significant. Pain scores did not reveal a significant difference between the groups.
Correlation analysis indicated a positive relationship between blood loss, operative time, and specimen weight. As specimen weight increased, both blood loss and operative time also increased, with significant findings observed between operative time and uterus weight. No significant correlations were noted between blood loss, operative time, and factors such as BMI, age, parity, hospital stay, pain scores, hemoglobin drop, or postoperative complications.
And intra-operative complications did not significantly differ between the two groups, and the mean hospital stay was similar in both the control and study groups.
As a result, we concluded that TLH with prior uterine artery clipping did not effectively reduce blood loss. However, it resulted in a longer operative time compared to conventional TLH. Our study findings are consistent with some previous studies but differ from others, highlighting the need for further research and larger studies to validate these results
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