Comparison of Perioperative Outcomes in Conventional Approach versus Posterior Approach for Uterine Artery Ligation in Total Laparoscopic Hysterectomy: A Randomized Control Trial.

BACKGROUND

Total laparoscopic hysterectomy (TLH) is commonly performed for benign gynecological conditions, with uterine artery ligation being a critical step due to its role as the major blood supply to the uterus.

AIMS AND

OBJECTIVES

To compare perioperative outcomes of conventional versus posterior uterine artery ligation during TLH.

MATERIALS AND

METHODS

A randomized controlled trial including 60 women meeting the inclusion criteria were selected and randomized into two different groups: Group A (conventional approach) and Group B (posterior approach), with 30 patients in each group. Baseline characteristics, including age, parity, BMI, previous surgery history, comorbidities, and menopausal status, were similar across groups.

RESULTS

Post-operative drop in hemoglobin level in each group has a significant difference; the hemoglobin drop was significantly greater in Group A (1.58 g/dl) compared to Group B (0.90 g/dl, P < 0.001). Estimated blood loss was also significantly higher in Group A (109.47 ml) than in Group B (78.33 ml, P < 0.001), reflecting reduced vascular injury and bleeding with the posterior approach. Additionally, operative time was noted to be shorter in Group B than Group A. The Mean of the operative time (minutes) in group A was 102.07 (10.22) and in group B was 92.27 (7.71). It was significantly higher in group A (P-value <0.001).

CONCLUSION

findings suggest that the posterior approach for uterine artery ligation during TLH is associated with less blood loss, reduced hemoglobin drop, and shorter operative times, indicating it may be a safer and more efficient method than the conventional approach.