The Comparison of Outcomes between the "Skeleton Uterus Technique" and Conventional Techniques in Laparoscopic Hysterectomies

Does Uterine Manipulator Type Affect Surgical Outcomes of Laparoscopic Hysterectomy?

Objectives:

Many surgeons use uterine manipulator (UM) during laparoscopic hysterectomy (LH). In this study, we aimed to compare the outcomes of LH operations performed by using partially reusable UM with the articulated system (artUM) and disposable (dUM) UM without articulation.

Materials and Methods:

A total of 99 patients underwent the LH operation. This study was carried out with 35 of those 99 Caucasian patients who met the inclusion criteria. Group 1 consisted for 7 LH operations using the articulated RUMI^® II/KOH-Efficient™ (Cooper Surgical, Trumbull, CT, USA) system (artUM), while Group II consisted of 28 patients using old-type V Care^®(ConMed Endosurgery, Utica, New York, USA) dUM as UM.

Results:

Mean operation time was found to be 157.1 ± 42.0 min. The operation time was found statistically longer in Group 1, consisted of artUM used patients (P = 0.006 and P < 0.05). No statistically significant difference was found between two groups in terms of surgical results such as, delta hemoglobin value (P = 0.483 and P < 0.05), length of hospital stay (P = 0.138 and P < 0.05), and postoperative maximum body temperature (P = 0.724 and P < 0.05).

Conclusion:

The UM type did not alter the surgical outcomes except the operating time in our study. According to our results, the surgical technique is a more significant variable than instruments used in LH for normal size uterus. Further prospective, large-scale studies comparing various UM systems are mandatory.

From Where Does the Uterine Artery Originate? A Prospective, Observational Laparoscopic Anatomic Study

STUDY OBJECTIVE

To determine and categorize the anatomic variations of the uterine artery (UA) as observed during laparoscopic hysterectomy with retroperitoneal dissection for benign conditions.

DESIGN

A prospective, observational study.

SETTING

A hospital department of obstetrics and gynecology, Uludag University Hospital, Bursa, Turkey.

PATIENTS

A total of 378 female patients who presented with indications for laparoscopic hysterectomy for benign disease.

INTERVENTIONS

Laparoscopic hysterectomy with retroperitoneal dissection was performed bilaterally in all patients between March 2014 and October 2018. The vascular anatomy beginning at the bifurcation of the common iliac artery down to the crossing of the UA with the ureter was exposed and subsequently studied. The UA was identified, and its variable branching patterns were recorded. The patterns were then categorized into groups adapted from classic vascular anatomy studies.

MEASUREMENTS AND MAIN RESULTS

Retroperitoneal dissections of 756 UAs were performed in 378 female patients. The UA was the first anterior branch of the internal iliac artery in 80.9% of the cases (Model 1; Main Model). Three additional models adequately described other variations of the UA as follows: Model 2 (Cross Model), 3.7%; Model 3 (Trifurcation Model), 3.1%; and Model 4 (Inverted-Y Model), 7.4%. The origin of the UA could not be determined in 7.4% of the cases.

CONCLUSION

The UA is the first anterior branch of the internal iliac artery in more than 80% of females. Surgeons should be aware of the anatomic variations of the UA to perform safe and efficient procedures.