Single port robot assisted total laparoscopic hysterectomy with bilateral uterine artery double ligation at the isthmic level of uterus

During Robot assisted total laparoscopic hysterectomy, there are many methods to deal with the uterine artery. We would like to introduce the effectiveness of selective uterine artery double ligation at the isthmic level of the uterus using ligature and loop in Robot assisted total laparoscopic hysterectomy.

Single port (SP) robotic surgery allows surgeons to be extremely accurate during complex procedures by higher degree of motion and higher definition, and makes it possible to do some procedures in a minimally invasive way. This is important because patients who have minimally invasive surgery have fewer complications. SP robotic surgery provides 3D imaging, and articulated, so dissection and suture are smoother even in narrow areas. We performed the surgery using the da Vinci SP robotic system.

After complete skeletonization of the uterine vessles, with the grasping vessel by robot arm taking hold of the uterine vessels just below the colpotomizer, and vessels was tightened up by polydioxanone suture needle that was passed beneath the vessels. The knots at the upper part of the colpotomizer were made and tightened over three times. The uterine vessels above the tie at the isthmic level right adjacent to the uterus were electro coagulated by bipolar coagulation to prevent backflow from the uterus. The ligature of the uterine vessels was cut 1-2 cm above the tie and the uterus was resected. After the uterus was resected robot assisted laparoscopically, each side of the pedicles of the uterine vessels was rebound by using Endoloop (Ethicon, Piscataway, NJ, USA), which was readily knotted to be applied and locked on a stump of vessels.

In conclusion, selective uterine artery double ligation at the isthmic level of the uterus inside leaves of broad ligaments was a feasible and secure method to manage uterine vessels for both patients and surgeons. This procedure could be done more elaborately through SP robotic surgery. Selective uterine artery double ligation in SP robot assisted ‘Total laparoscopic hysterectomy’ appears to be safer during operation. Also, it did not take a longer time for operation.