Academic Journal
Uterine artery closure at the origin versus at the uterus level in total laparoscopic hysterectomy: A randomized controlled trial
| العنوان: | Uterine artery closure at the origin versus at the uterus level in total laparoscopic hysterectomy: A randomized controlled trial |
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| المؤلفون: | Uccella S., Garzon S., Lanzo G., Gallina D., Bosco M., Porcari I., Gueli-Alletti S., Cianci S., Franchi M., Zorzato P. C. |
| المساهمون: | Uccella, S., Garzon, S., Lanzo, G., Gallina, D., Bosco, M., Porcari, I., Gueli-Alletti, S., Cianci, S., Franchi, M., Zorzato, P. C. |
| بيانات النشر: | John Wiley and Sons Inc |
| سنة النشر: | 2021 |
| المجموعة: | Università degli Studi di Messina: IRIS |
| مصطلحات موضوعية: | hysterectomy, laparoscopy, randomized controlled trial, surgical blood loss, uterine artery |
| الوصف: | Introduction: The transfusion rate in hysterectomies for benign pathology is almost 3%. However, despite the strong interest in reducing intraoperative bleeding, limited evidence is available regarding the technical aspects concerning uterine vessel management during a total laparoscopic hysterectomy (TLH). Uterine artery (UA) closure in TLH can be performed at the origin from the internal iliac artery or at the uterus level (UL). However, low-quality evidence is available regarding the superiority of one method over the other. Material and methods: We performed a single-blind randomized (1:1) controlled trial (NCT04156932) between December 2019 and August 2020. One hundred and eighty women undergoing TLH for benign gynecological diseases were randomized to TLH with UA closure at the origin from the internal iliac artery (n = 90), performed at the beginning of the procedure by putting two clips per side at the origin, versus closure at the UL (n = 90). Intraoperative blood loss estimated from suction devices was the primary outcome. Secondary end points were perioperative outcomes, the conversion rate from one technique to the other, and complication rates with 4 months of follow up. Results: Uterine artery closure at the origin was completed in all 90 patients (0%), whereas closure at the UL was converted to closure at the origin in 11 cases (12.2%; p < 0.001); failures were mainly associated with the presence of endometriosis (81.8% [9/11] versus 10.1% [8/79]; p < 0.001). In the intention-to-treat analysis, the intraoperative blood loss was higher in the group assigned to the closure at the UL (108.5 mL) than in the group with closure at the origin (69.3 mL); the mean difference was 39.2 mL (95% CI 13.47–64.93 mL; p = 0.003). Other perioperative outcomes and complications rates did not differ. Conclusions: Uterine artery closure at the origin reduces intraoperative blood loss during a TLH and appears to be more reproducible than closure at the UL without higher complication rates. However, the absent ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | STAMPA |
| اللغة: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/34396512; info:eu-repo/semantics/altIdentifier/wos/WOS:000684955900001; volume:100; issue:10; firstpage:1840; lastpage:1848; numberofpages:9; journal:ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA; https://hdl.handle.net/11570/3211333; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85112407663 |
| DOI: | 10.1111/aogs.14238 |
| الاتاحة: | https://hdl.handle.net/11570/3211333 https://doi.org/10.1111/aogs.14238 https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.14238 |
| Rights: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.E5EE6765 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1111/aogs.14238 |
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