Effect of Bilateral Uterine Artery Ligation on Blood Loss during Total Laparoscopic Hysterectomy

Mostafa Bahaa ^1* Ahmed El-Minawi ² Hossam El-Shenoufy ² Ahmed Hussein ² Hesham El-Fazary ³ Alaa A Alsharif ⁴ Hayam Ali Alrasheed ⁴ Mostafa Eldardiry ⁵

• ¹ Faculty of Pharmacy, Horus University, Damietta, Egypt
• ² Cairo University, Giza, Giza, Egypt
• ³ Alexandria University, Alexandria, Alexandria, Egypt
• ⁴ Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
• ⁵ Kafrelsheikh University, Kafr el-Sheikh, Kafr el-Sheikh, Egypt

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 to evaluate blood loss and perioperative outcomes.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 till skin suturing), intraoperative and postoperative complications, postoperative analgesic needs, and hospital stay. Results: Both groups were demographically similar. The BUAL group had 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 minutes) than in the CTLH group (160.50 ± 19.75 minutes). 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 offers a feasible alternative to conventional methods, despite a slightly longer operative time.Enhanced surgical expertise correlates with reduced operative duration and improved outcomes.