Total Laparoscopic Hysterectomy With Prior Uterine Artery Cauterization From the Origin Versus Conventional Laparoscopic Hysterectomy

The main goal of this study is to compare between total Laparoscopic hysterectomy proceeded by Uterine artery cauterization at its origin and conventional total Laparoscopic hysterectomy regarding: bleeding , operative time , intra operative time and follow up post operative.

Study Overview

• Status: Not yet recruiting
• Conditions: Laparoscopic Hysterectomy
• Intervention / Treatment: Procedure: Total Laparoscopic hysterectomy with prior Uterine artery cauterization from the origin to arm 1; Procedure: Conventional Laparoscopic hysterectomy to arm 2; Procedure: Total Laparoscopic hysterectomy with conventional uterine artery ligation

Detailed Description

The most common non-pregnancy-related gynecological procedure performed for women is a hysterectomy. (Uwais et al,. 2024 )In Germany, the incidence of hysterectomy ranges from 2.13 to 3.62/1000, while in the United States, it is 5.4/1000. In the US, about 600,000 hysterectomy surgeries are carried out each year. (Harvey et al ,. 2022 ) Fibroids, adenomyosis, endometriosis, dysfunctional uterine bleeding, uterine prolapse, and premalignant and malignant lesions are among the many indications for a hysterectomy. (Singh et al ,. 2024 ) Traditionally , hysterectomy has been done abdominally or by vaginal route . In the present era , Laparoscopic hysterectomy has recently received a considerable respect as a favourable hysterectomy technique . ( Bartels et al ,. 2020 ) Laparoscopic hysterectomy is a safe , workable technique , provides minimal post operative discomfort, shorter hospital stay , rapid convalescence , early return to daily activities. ( Pepin , K. et al ., 2020 ).

Selection of route of hysterectomy can be influenced by size , shape of the vagina and uterus, accessibility of the uterus, extent of extra uterine disease , surgeon experience, available hospital support, whether the case is emergent or scheduled and preference of the informed patient . ( Panda et al ,. 2022 )

.As Laparoscopic surgery becomes more advanced and widely applied, the absolute contraindications to laparoscopy are diminishing . Patient limitations to Laparoscopic surgery can be both anatomical and physiological .

Adverse anatomical limitations include difficult access to the abdomen , obliteration of the peritoneal space , organomegaly , intestinal distension and the potential for cancer dissemination.

The major physiological obstacles to safe Laparoscopy include increased intracranial pressure, abnormalities in cardiac output and gas exchange in the lung , chronic liver disease and coagulopathy . These anatomical and physiological conditions were formerly considered absolute contraindications to laparoscopy, they are now considered only relative contraindications.( Madhok et al ,. 2022 )

. The uterus receives the majority of its blood supply from the uterine artery, a branch of the internal iliac artery. In order to reach the uterine cervix, the uterine artery is first found 2.5 cm lateral and superior to the ureter before crossing it anteriorly to its medial side .( Selcuk I et al ,. 2018).

The ureter is more susceptible to injury during oophorectomy and hysterectomy because of its close relationship to the ovary, where it lies beneath the insertion of the infundibulopelvic ligament at the pelvic brim, and its relationship to the uterine artery, where it passes inferior to the uterine artery.( Lescay et al ,. 2024 )

Although total Laparoscopic hysterectomy (TLH ) is generally safe .There is a potential risk of complications may occur . Excessive blood loss during TLH is still an issue which need blood transfusion especially in case of large uteri . ( Saad _ Naguib M et al , .2022) .

During TLH, the uterine arteries (UAs) must be closed effectively.Closing UAs at the uterine level or at the origin from the internal iliac artery are the two main options . The decision is solely based on the preferences and opinions of the surgeon.( Uccella et al ,. 2021) .

There is a shortage in data that compare two techniques , therefore , Current study will be conducted to compare feasibility, duration of the surgery , estimated blood loss , post operative complications during conventional Laparoscopic hysterectomy versus early Uterine artery cauterization at its origin .

• Study Type: Interventional
• Enrollment (Estimated): 44
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Hadeer Ali Elashry, Master degree; Phone Number: +2 01012402227; Email: hadeer.alashry1997@gmail.com
• Study Contact Backup: Name: Mustafa Farag Ellakany, Lecturer; Phone Number: +2 01016083210

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria: Age of the patient is more than 35 y . Non malignant pathologies including fibroids, endometrial hyperplasia, Dysfunctional Uterine bleeding not responding to medical treatment.

Good general condition of the patient ( American society of Anesthesiologists "ASA" score 1 , 2 , 3 ( Horvath et al ,. 2021) .

Uterine size is less than 20 weeks by fundal level . -

Exclusion Criteria:Age of the patient is less than 35 y . Gynecological malignancies . Contraindications for laparoscopy as any medical condition worsens by peumo peritoneum or Trendelenburg position as severely compromised cardiopulmonary status .

Patients with American society of Anesthesiologists score 4 or more . ( Horvath et al ,. 2021) Uterine size is more than 20 weeks by fundal level .

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Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Total Laparoscopic hysterectomy with prior uterine artery cauterization from the origin; Total Laparoscopic hysterectomy with prior Uterine artery cauterization from the origin take less time and cause less bleeding	Procedure: Total Laparoscopic hysterectomy with prior Uterine artery cauterization from the origin to arm 1; Total Laparoscopic hysterectomy with prior Uterine artery cauterization from the origin to arm 1
Experimental: Conventional Total Laparoscopic hysterectomy; Conventional Total Laparoscopic hysterectomy may cause more blood loss and take more time	Procedure: Conventional Laparoscopic hysterectomy to arm 2; Conventional Laparoscopic hysterectomy; Procedure: Total Laparoscopic hysterectomy with conventional uterine artery ligation; Total Laparoscopic hysterectomy with ligation of uterine artery beside uterus is considered conventional and may cause more blood loss and take more time

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Is to compare peri operative blood loss by counting amount of blood in ml drained by suction , operation time between Conventional TLH and TLH with prior occlusion to UAs at its origin	Is to compare peri operative blood loss by counting amount of blood in ml drained by suction , operation time between Conventional TLH and TLH with prior occlusion to UAs at its origin	24 hours after surgery
Is to compare peri operative blood loss , operation time between Conventional TLH and TLH with prior occlusion to UAs at its origin	Is to compare peri operative blood loss , operation time between conventional TLH and TLH with prior Uterine artery occlusion	One week after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Post operative pain , difference in Hemoglobin level in mg /dl pre and post operative, frequency of post operative hematoma in cm detected by us at vaginal vault and ureteric complications	Post operative pain , difference in Hemoglobin level in mg / dl pre and post operative, frequency of post operative hematoma in cm detected by us at vaginal vault and ureteric complications	24 hours postoperative

Collaborators and Investigators

• Sponsor: Kafrelsheikh University

Study record dates

Study Major Dates

• Study Start (Estimated): May 15, 2026
• Primary Completion (Estimated): May 15, 2027
• Study Completion (Estimated): June 15, 2027

Study Registration Dates

• First Submitted: July 9, 2025
• First Submitted That Met QC Criteria: May 15, 2026
• First Posted (Actual): May 22, 2026

Study Record Updates

• Last Update Posted (Actual): May 22, 2026
• Last Update Submitted That Met QC Criteria: May 15, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: Total Laparoscopic hysterectom

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No