Obstet Gynecol Sci.  2016 Jan;59(1):39-44. 10.5468/ogs.2016.59.1.39.

Total laparoscopic hysterectomy via suture and ligation technique

• Kang HW
• Lee JW
• Kim HY
• Kim BW
• Moon CS

• KMID: 2152642
• DOI: http://doi.org/10.5468/ogs.2016.59.1.39

Abstract

OBJECTIVE
The term 'total laparoscopic hysterectomy (TLH) with classical suture method' refers to a surgical procedure performed using only sutures and ligations with intracorporeal or extracorporeal ties, without using any laser or electronic cauterization devices during laparoscopic surgery as in total abdominal hysterectomy. However, the method is not as widely used as electric coagulation equipment for TLH because further advances in technology and surgical technique are required and operative time can take longer. In the current study, we evaluated the benefits of the classical suture method for TLH.
METHODS
This study retrospectively reviewed patients who received TLH using the classical suture method from August 2005 to April 2014. The patients' baseline characteristics were analyzed, including age, parity, cause of operation, medical and surgical history. Surgical outcomes analyzed included the weight of the uterus, operative time, complications, changes in hemoglobin level, blood transfusion requirements, and postoperative hospital stay.
RESULTS
Of 746 patients who underwent TLH with the classical suture method, mean operation time was 96.9 minutes. Mean average decline in hemoglobin was 1.6 g/dL and transfusion rate was 6.2%. Urinary tract injuries were reported in 8 patients. Urinary tract injuries comprised 6 cases of bladder injury and 3 cases of ureter injury. There were no cases of vaginal stump infection, hematoma, bowel injury or abdominal wound complication. All cases involving complications occurred before 2010.
CONCLUSION
The classical suture method for TLH presents tolerable levels of complications and blood loss. Advanced surgical skill is expected to decrease operation time and complications.

Keyword

Classical suture; Hysterectomy; Laparoscopy

MeSH Terms

Blood Transfusion
Cautery
Female
Hematoma
Humans
Hysterectomy*
Laparoscopy
Length of Stay
Ligation*
Operative Time
Parity
Retrospective Studies
Sutures*
Ureter
Urinary Bladder
Urinary Tract
Uterus
Wounds and Injuries

Figure

• 

  Fig. 1 Round ligament and ovarian ligament were sutured by the laparoscopic extracorporal technique (A). The proximal site was cut, and the distal site was reinforced by loop (B).

• 

  Fig. 2 The uterine vessel and cardinal ligament were sutured by the laparoscopic extracorporal technique (A). The proximal site was cut, and the distal site was reinforced by loop (B).

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