Prospective cohort study: vascular clamping of uterine artery combined with sacral ligament plication in complex hysterectomy.

Abstract

<h4>Objective</h4>To evaluate the clinical efficacy of the combined technique involving Hem-o-lok clip closure of the uterine artery trunk and uterosacral ligament plication in laparoscopic complex hysterectomy.<h4>Methods</h4>A prospective study included 100 patients undergoing laparoscopic complex hysterectomy at our hospital from January 2021 to June 2022. Patients were divided into the conventional group (n = 50) and the combined group (n = 50) based on surgical techniques. The conventional group underwent standard electrocoagulation closure of the ascending uterine artery branch at the cervical isthmus level and simple vaginal cuff suture, while the combined group utilized Hem-o-lok vascular clips for early uterine artery trunk closure and additional uterosacral ligament plication fixation to the vaginal cuff. Intraoperative blood loss, operative time, postoperative recovery indicators, and 3-year follow-up outcomes-including pelvic floor function (POP-Q staging, PFDI-20 score) and sexual quality of life (FSFI score)-were compared.<h4>Results</h4>Compared with the conventional group, the combined group demonstrated significantly reduced intraoperative blood loss (68.7 ± 15.2 vs.95.2 ± 18.4mL, P < 0.001) higher surgical field visibility scores (4.8 ± 0.3 vs. 3.1 ± 0.7, P < 0.01), faster postoperative recovery, and lower hospitalization costs. At 3-year follow-up, the combined group exhibited lower rates of POP-Q stage ≥Ⅱ (6% vs. 24%, P < 0.01), longer vaginal length (8.1 ± 0.8 vs. 7.0 ± 1.2 cm, P < 0.01), lower PFDI-20 scores (18.5 ± 4.5 vs. 35.7 ± 7.8, P < 0.01), and higher FSFI scores (25.2 ± 2.6 vs. 20.3 ± 4.1, P < 0.01).<h4>Conclusion</h4>T The combined technique of uterine artery trunk closure with Hem-o-lok clips and uterosacral ligament plication significantly improved surgical efficiency without increasing major complications. Furthermore, in this prospective cohort, it was associated with a shorter operative time, less blood loss, and better pelvic floor and sexual function metrics at the 3-year follow-up compared to the conventional technique.