title: Laparoscopic-assisted vaginal hysterectomy with uterine artery ligation through retrograde umbilical ligament tracking.
abstract: OBJECTIVE
  To evaluate the clinical outcomes of uterine artery ligation through retrograde tracking of the umbilical ligament (RUL) in laparoscopic-assisted vaginal hysterectomy (LAVH).
  
  
  METHODS
  Prospective study (Canadian Task Force classification II-3).
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Two hundred twenty-five women with myomas or adenomyosis.
  
  
  METHODS
  Laparoscopic-assisted vaginal hysterectomy with uterine artery identification and ligation through RUL.
  
  
  RESULTS
  The median age of the patients was 46 years, and the median weight of the extirpated uteri was 340 g, with 26.2% of uteri weighing more than 500 g. The median operation time was 135 minutes, and the median blood loss was 50 mL. The median intramuscular meperidine requirements were 1 ampoule (50 mg), and the median hospital stay was 3 days. It took approximately 10 minutes from identification of the umbilical ligament to ligation of the uterine artery. Uterine weight of 500 g or more required a significantly longer operation time compared with uteri weighing less than 500 g (164 min vs 127 min median, p <.001), and there was more blood loss (100 mL vs 50 mL median, p <.001). There were no differences in the median intramuscular meperidine requirements or hospital stay between the two groups. No blood transfusion was needed in either group, even in patients with a uterine weight of more than 1000 g. By regression analysis, uterine weight was significantly related to blood loss and operation time. A linear relationship was found among uterine weight, operation time, and blood loss: Uterine weight = 87.589 + 1.881 x operation time + 0.48 x blood loss (R = 0.531, F = 35.694, degrees of freedom 184, p <.001). No complications related to RUL were observed, although two bladder injuries related to severe pelvic adhesion with endometriosis and previous cesarean section occurred.
  
  
  CONCLUSIONS
  Minimal blood loss and a low complication rate were noted in LAVH by uterine artery ligation through RUL. This technique should be a valid approach, especially in patients in whom minimal blood loss must be achieved.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Pao-Ling
authors.initials: PL
authors.lastname: Torng
authors.forename: Su-Cheng
authors.initials: SC
authors.lastname: Huang
authors.forename: Bor-Ching
authors.initials: BC
authors.lastname: Sheu
authors.forename: Wen-Chiung
authors.initials: WC
authors.lastname: Hsu
authors.forename: Ruey-Jien
authors.initials: RJ
authors.lastname: Chen
authors.forename: Song-Nan
authors.initials: SN
authors.lastname: Chow
authors.forename: Daw-Yuan
authors.initials: DY
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D007902:Length of Stay; D008026:Ligation; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D012044:Regression Analysis; D014591:Uterine Diseases / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery; D014599:Uterus / Q000098:blood supply*