Alumi Laparoscopic Discussion Board

Regarding Laparoscopic Hysterectomy
Discussion in 'All Categories' started by Dr. Jeffrey Moscow - Jul 23rd, 2016 8:05 am.
Dr. Jeffrey Moscow
Dr. Jeffrey Moscow
Hi!

I see you ligating the uterine artery always during laparoscopic hysterectomy. Can you explain the real benefit of that. Majority of surgeon are just using vessel sealer and it looks fine. What is the need of this ligation. In my opinion it is unnecessary increasing the surgical time.
re: Regarding Laparoscopic Hysterectomy by Dr R K Mishra - Jul 24th, 2016 9:02 am
#1
Dr R K Mishra
Dr R K Mishra
Dear Dr. Jeffrey Moscow

Ligation of Uterine artery in TLH is my personal choice and I use Mishra's extracorporeal knot during Total laparoscopic hysterectomy.

Although it is not necessary to ligate uterine artery if you are using the advanced energy sources like Ligasure, Enseal or Thunderbeat. However, ligation of uterine artery will increase your confidence level and it will decrease the chances of blood loss and injury to ureter.

Selective uterine artery ligation by Mishra's knot in TLH showed lower transfusion rate, less hospitalization and less discomfort due to drain than bipolar uterine artery coagulation. Also, it did not take a longer time for operation and thus provides a feasible and secure method to manage uterine vessels at the level of uterine isthmus inside of the broad ligament after opening anterior and posterior leaf of broad ligament.

Bite with the 30 mm Endoski needle should be taken just above and lateral to the angle where cervical part of uterosacral ligament joins the uterus cervical part. You must have seen many videos of our ligation technique on the YouTube and with this technique our average blood loss in TLH is just 20 ml.
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