Clips versus bipolar coagulation for uterine vessel ligation in laparoscopic hysterectomy: A prospective randomized trial
DOI:
https://doi.org/10.37800/RM.3.2026.809Keywords:
Total laparoscopic hysterectomy, uterine artery ligation, surgical blood lossAbstract
Relevance: Total laparoscopic hysterectomy (TLH) is widely regarded as the preferred minimally invasive approach for benign gynecologic conditions. However, the best method for uterine artery ligation remains debated, especially regarding blood loss, operative time, and overall surgical safety.
The study aimed to compare bipolar coagulation at the uterine level during total laparoscopic hysterectomy for benign gynecologic diseases with ligation of the uterine artery at its origin using clips.
Materials and Methods: This prospective, randomized, controlled, parallel-group study was conducted from January 2023 to January 2026 at Mansoura University Hospital, Egypt. The study included 70 women scheduled for laparoscopic hysterectomy due to benign gynecologic conditions. The night before surgery, they were randomly divided equally into two groups: in Group A, clips were used to occlude the uterine arteries at their origin; in Group B, bipolar electrocoagulation was used to occlude the uterine arteries near the uterus.
Results: The mean age was 47.57 ± 5.36 years in Group A vs. 48.09 ± 5.61 years in Group B. Most patients in both groups were perimenopausal (82.9% and 88.6%). The average operative time was 104.43 ± 12.47 min in Group A vs. 64.43 ± 12.29 min in Group B (p = 0.001). The mean blood loss was 116.29 ± 39.85 mL vs. 131.43 ± 40.38 mL (p = 0.119). No urinary, intestinal, or major vascular injuries were observed. The mean postoperative hospital stay was 2.85 ± 0.36 days in Group A vs. 2.70 ± 0.467 days in Group B (p = 0.146).
Conclusion: Ligation of the uterine artery at its origin before TLH is a safe and feasible procedure. Although intraoperative blood loss tended to be lower in the clips group, the difference between the groups did not reach statistical significance. In contrast, the clips technique was associated with a significantly longer operative duration.
References
1. Miller E, Haworth LA, Jones J, Woo JJ. Uterine artery occlusion techniques: tips and tricks... and some pitfalls. J Minim Invasive Gynecol. 2022 Nov;29(11):S84.
https://doi.org/10.1016/j.jmig.2022.09.273
2. Marwah V, Dutta S, Kedia S, Mittal P. Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources. Facts Views Vis Obgyn. 2021 Jun;13(2):149.
https://doi.org/10.52054/FVVO.13.2.018
3. El-Minawi A, El-Shenoufy H, Hussein A, El-Fazary H, Bahaa MM, Alsharif AA, AlRasheed HA, Eldardiry M. Effect of bilateral uterine artery ligation on blood loss during total laparoscopic hysterectomy. Front Med (Lausanne). 2025 May;12:1577904.
https://doi.org/10.3389/fmed.2025.1577904
4. Abi Antoun M, Etrusco A, Chiantera V, Laganà AS, Feghali E, Khazzaka A, Stabile G, Della Corte L, Dellino M, Sleiman Z. Outcomes of conventional and advanced energy devices in laparoscopic surgery: a systematic review. Minim Invasive Ther Allied Technol. 2024 Feb;33(1):1–2.
https://doi.org/10.1080/13645706.2023.2274396
5. Kim SI, Lee SJ, Yoon JH. Non-electrical ligation of vessels using Hem-o-lok clips ensures no electrical ureteral injury during total laparoscopic hysterectomy. Clin Exp Obstet Gynecol. 2023 Mar;50(3):64.
https://doi.org/10.31083/j.ceog5003064
6. Zorzato PC, Ferrari FA, Garzon S, Franchi M, Cianci S, Laganà AS, Chiantera V, Casarin J, Ghezzi F, Uccella S. Advanced bipolar vessel sealing devices vs conventional bipolar energy in minimally invasive hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024 Apr;309(4):1165–1174.
https://doi.org/10.1007/s00404-023-07270-8
7. Purohit R, Sharma JG, Meher D. A vagino-laparoscopic strategy for hysterectomy of large uteri to ease surgical challenges. Int J Womens Health. 2023 Dec;15:369–379. https://doi.org/10.2147/IJWH.S400587
8. Uccella S, Garzon S, Lanzo G, Gallina D, Bosco M, Porcari I, Gueli-Alletti S, Cianci S, Franchi M, Zorzato PC. Uterine artery closure at the origin vs at the uterus level in total laparoscopic hysterectomy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2021 Oct;100(10):1840–1848.
https://doi.org/10.1111/aogs.14238
9. Lysdal VK, Karampas G, Rudnicki M. Lateral closure of the uterine artery prior to laparoscopic hysterectomy: a systematic review. J Obstet Gynaecol. 2022 Jul;42(5):785–792. Epub 2021.
https://doi.org/10.1080/01443615.2021.1968810
10. Lampé R, Margitai N, Török P, Lukács L, Orosz M. A Stepwise Anatomy-Based Protocol for Total Laparoscopic Hysterectomy: Educational Tool with Broad Clinical Utility. Diagnostics. 2025 Jul 8;15(14):1736.
https://doi.org/10.3390/diagnostics15141736
11. Bhattacharjee R, Pandey S, Ganjiwale J, Shahu S, Shah D, Pindoria M. Role of uterine artery occlusion at origin during total laparoscopic hysterectomy in non-malignant cases for optimal surgical outcome. Int J Gynaecol Obstet. 2025 Dec;171(3):1325–1334.
https://doi.org/10.1002/ijgo.70265
12. Poojari VG, Bhat VV, Bhat R. Total laparoscopic hysterectomy with prior uterine artery ligation at its origin. Int J Reprod Med. 2014;2014:420926.
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