title: Ligation of uterine vessels in total laparoscopic hysterectomy using Hem-o-lok clips.
abstract: OBJECTIVE
  The Hem-o-lok clip ligation has become the preferred method for vessel ligation. We evaluated the feasibility and safety of uterine vessel ligation using the Hem-o-lok clip during total laparoscopic hysterectomy.
  
  
  METHODS
  The clinical outcomes of 58 hysterectomies were compared between the following two groups: Hem-o-lok clip group (n = 29) and bipolar coagulation group (n = 29).
  
  
  RESULTS
  Of the 29 patients in the Hem-o-lok clip group, bilateral application of Hem-o-lok clips was completed in 25 patients (86%); unilateral use of the bipolar coagulator was needed in four patients for rapid control of bleeding from lacerated uterine vessels during dissection and/or because of anatomical difficulty. No complications, such as dislodgement, slippage, or bleeding, were identified in the Hem-o-lok clip group. No difference was identified in surgical outcomes, such as blood loss or operative time, between the two groups. Postoperative pelvic infections occurred in one patient from each group with unilateral and bilateral use of the Hem-o-lok clip; the ligated uterine vessels using the Hem-o-lok clip were intact, but the coagulated uterine vessels were weakened by the pelvic infections, which caused active uterine bleeding requiring emergent reoperation.
  
  
  CONCLUSIONS
  The Hem-o-lok clip could be used for ligation of uterine vessels and might be resistant to pelvic infections compared with bipolar coagulation. Prospective randomized trials are needed to confirm the real clinical benefit of this surgical approach.
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University, Seoul, Republic of Korea.
authors: Jae Eun
authors: JE
authors: Lee
authors: Biomedical Engineering Branch, Division of Convergence Technology, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors: Kwang Gi
authors: KG
authors: Kim
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors: Dong Ock
authors: DO
authors: Lee
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors: Sang Soo
authors: SS
authors: Seo
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors: Sokbom
authors: S
authors: Kang
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors: Sang-Yoon
authors: SY
authors: Park
authors: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address: gynlim@gmail.com.
authors: Myong Cheol
authors: MC
authors: Lim
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation*; D010535:Laparoscopy; D008026:Ligation / Q000295:instrumentation; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation; D013537:Sutures; D055988:Uterine Artery / Q000601:surgery*; D014591:Uterine Diseases / Q000601:surgery*; D014599:Uterus / Q000098:blood supply* / Q000601:surgery
keywords: Hem-o-lok clip; total laparoscopic hysterectomy; uterine vessel