A new knotless parametrial tissue ligation technique for safe total laparoscopic hysterectomy
- Author:
Ju Hee KIM
1
;
Hea Yeon CHOI
;
Yong Hee PARK
;
Sung Hoon KIM
;
Hee Dong CHAE
;
Sa Ra LEE
Author Information
- Publication Type:Original Article
- From:Obstetrics & Gynecology Science 2024;67(1):120-131
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:Parametrial tissue ligation during total laparoscopic hysterectomy (TLH) is important in large uteri with large vessels.
Methods:A retrospective study was performed at Asan Medical Center for comparing TLH performed with a new knotless parametrial tissue ligation method and conventional laparoscopic-assisted vaginal hysterectomy (LAVH) from March 2019 to August 2021. For TLH, after anterior colpotomy, the parametrial tissue was ligated by anchoring the suture and making a loop in one direction three times using 1-0 V-LocTM 180 (Covidien, Mansfield, MA, USA) suture. Subsequently, the cranial part of the loop was cut using an endoscopic device.
Results:A total of 119 and 178 patients were included in the TLH and LAVH groups, respectively. The maximal diameter of the uterus was larger in the TLH group (106.29±27.16 cm) than in the LAVH group (99.00±18.92 cm, P=0.01). The change in hemoglobin (Hb) level was greater in the LAVH group than in the TLH group (P<0.001). The weight of the removed uterus was greater in the TLH group than in the LAVH group (431.95±394.97 vs. 354.94±209.52 g; P=0.03). However, when the uterine weight was >1,000 g, the operative times and change in Hb levels were similar between the two groups. In both groups, no ureteral complications occurred during or after surgery.
Conclusion:Knotless parametrial tissue ligation using 1-0 V-LocTM 180 suture in TLH can be safely applied, even in cases with large uteri, without increased risks of ureteral injury or uterine bleeding.
