A modified procedure of laparoscopic hysterectomy: Preligating the uterine arteries with polydioxanone clips

For increasing the safety of the desiccation procedure of uterine arteries by bipolar cauterization during laparoscopic hysterectomy, we developed a new technique in which Polydioxanone clips were placed at the uterine arteries before the uterine vessels were desiccated. In total, 22 consecutive cases of uterine tumors were included for laparoscopic hysterectomy with the bipolar cauterization technique. In the study group (n = 11), two Polydioxanone clips were placed at the section of each uterine artery, which is located between the ureter and the bifurcation of the hypogastric artery, before desiccation of uterine vessels during the hysterectomy procedure. The other 11 cases as the control group were performed by the usual bipolar techniques of laparoscopic hysterectomy. A comparison of the operative results was made between the two groups. No significant difference was noted in the age, uterine weights, and operation time between the two groups. The operation duration was 125 +/- 18.7 min in the control group and 115.73 +/- 13.07 min in the study group. The drop in hemoglobin level in the control group was 2.12 +/- 0.58 mg/dl, and that in the study group was 1.23 +/- 0.37 mg/dl. The estimated blood loss of the study group was reduced significantly compared with that of the control group (p < 0.001). Our preliminary data indicate that this new technique seems to be able to reduce the blood loss during operation, yet not increase the operation time. Our procedure can prevent excessive bleeding from uterine vessels and thermal injury of ureters. Delayed bleeding from the cut end of desiccated uterine arteries will no longer be a concern.