Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 2:12:1577904.
doi: 10.3389/fmed.2025.1577904. eCollection 2025.

Effect of bilateral uterine artery ligation on blood loss during total laparoscopic hysterectomy

Ahmed El-Minawi  1 , Hossam El-Shenoufy  1 , Ahmed Hussein  1 , Hesham El-Fazary  2 , Mostafa M Bahaa  3 , Alaa A Alsharif  4 , Hayam Ali AlRasheed  4 , Mostafa Eldardiry  5
Affiliations

Effect of bilateral uterine artery ligation on blood loss during total laparoscopic hysterectomy

Ahmed El-Minawi et al. Front Med (Lausanne). .

Abstract

Background: Hysterectomy is a common major gynecological surgery. Total laparoscopic hysterectomy (TLH) has become a preferred method over traditional approaches due to its minimally invasive nature and reduced postoperative complications.

Aim: This study aimed to compare conventional total laparoscopic hysterectomy (CTLH) with TLH involving bilateral uterine artery ligation (BUAL) at its origin, specifically evaluating blood loss and perioperative outcomes.

Methods: In this prospective randomized study conducted at Cairo University Hospital, 60 female patients undergoing TLH for benign uterine conditions were randomized. Group 1 (BUAL) involved bilateral uterine artery ligation at its origin, and Group 2 (CTLH) followed conventional TLH techniques. Preoperative assessments included comprehensive history, physical examinations, and relevant laboratory tests. Outcomes measured were intraoperative blood loss, operative time (from insufflation to skin suturing), intraoperative and postoperative complications, postoperative analgesic needs, and hospital stay.

Results: Both groups were demographically similar. The BUAL group experienced significantly lower blood loss (103.7 ± 23.27 mL) compared to the CTLH group (128.7 ± 42.57 mL) (p < 0.05). However, the mean operative time was slightly longer in the BUAL group (169.33 ± 15.85 min) than in the CTLH group (160.50 ± 19.75 min). No major surgical complications or blood transfusions were reported in either group. The posterior approach to uterine artery ligation in the BUAL group was more time-efficient.

Conclusion: Securing the uterine arteries at their origin during TLH reduces blood loss and provides a feasible alternative to conventional methods, despite a slightly longer operative time. Enhanced surgical expertise correlates with reduced operative duration and improved outcomes.

Keywords: blood loss; operative time; postoperative recovery; surgical complications; total laparoscopic hysterectomy; uterine artery ligation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CONSORT flowchart displaying the flow of participants during the study.
Figure 2
Figure 2
Correlation analysis between (A) operative time and blood loss in the BUAL group and (B) between operative time and hemoglobin in the BUAL group.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sandhu K, Wilson R, Yao M, Hackett L, Orlando M, Kho R. Racial and ethnic disparities in rates of minimally invasive hysterectomy across the United States: a systematic review. Am J Obstet Gynecol. (2024) 230:S1224–5. doi: 10.1016/j.ajog.2024.02.129 - DOI
    1. Jain V, Jain N. Laparoscopic port placement for TLH In: Complex Total laparoscopic hysterectomy (TLH) with newer approaches in bladder dissection. Springer Nature Singapore: Springer; (2024). 27–41.
    1. Neis F, Ayguen A, Sima RM, Solomayer EF, Juhasz-Boess I, Wagenpfeil G, et al. . Access to hysterectomy—what is the realistic rate for pure vaginal hysterectomy? A single-center prospective observational study. J Clin Med. (2024) 13:6130. doi: 10.3390/jcm13206130, PMID: - DOI - PMC - PubMed
    1. Gendy R, Walsh CA, Walsh SR, Karantanis E. Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol. (2011) 204:388. e1–8. doi: 10.1016/j.ajog.2010.12.059 - DOI - PubMed
    1. Drymiotou S, Dokmeci M, Chandrasekaran D, Jeyarajah A, Brockbank E. Impact of minimally invasive surgery on surgical outcomes for obese women with endometrial cancer following robotic surgery introduction; a single Centre study. Int J Med Robot Comput Assisted Surg. (2024) 20:e2559. doi: 10.1002/rcs.2559, PMID: - DOI - PubMed

LinkOut - more resources