Management of the lower uterine ligament in total laparoscopic hysterectomy: options for managing the uterine artery and cardinal ligament

Abstract

In management of the lower uterine ligament during total laparoscopic hysterectomy (TLH), it is necessary to ensure maintenance of hemostasis and prevent hemorrhage from the cardinal ligament as well as to avoid accidental injury of the ureter. Various methods are available for management of the lower uterine ligament that differ with regard to the facilities, operator skill, and equipment required. We divided these methods of managing the uterine artery and cardinal ligament when performing TLH into four groups, and the advantages and disadvantages of each method were examined. The results indicated a tendency to ligate the uterine artery and cardinal ligament in cases where the uterine weight is heavy and intrapelvic adhesion is advanced. However, the frequency of cardinal ligament ligation was decreased after introducing the vessel sealing system in our hospital. In management of the cardinal ligament and uterine artery when performing TLH, it is important to use the most appropriate method for management of the lower uterine ligament for each individual case, and it is also very important to introduce effective surgical equipment for these procedures. This may lead to improvements in the safety of surgery, reduce operation times, and improve education for young doctors.