Comparing two Uterine Manipulators During Total Laparoscopic Hysterectomy: A Randomized Controlled Trial

Area of Science:

• Gynecologic Surgery
• Minimally Invasive Procedures
• Surgical Instrumentation

Background:

• Total laparoscopic hysterectomy (TLH) is a common gynecologic procedure.
• Uterine manipulators are essential tools in TLH, aiding in visualization and surgical access.
• Different types of uterine manipulators exist, with varying designs potentially impacting surgical outcomes.

Purpose of the Study:

• To compare the efficacy and safety of two uterine manipulators: the tight-fitting Colpo-Probe Vaginal Fornix Delineator and the loose-fitting Hohl manipulator.
• To evaluate operative times, specifically colpotomy duration and time from skin incision to uterine detachment.
• To assess the extent of thermal damage to the vaginal cuff associated with each manipulator.

Main Methods:

• A randomized controlled trial was conducted involving women undergoing TLH.
• Patients were randomly assigned to use either the Colpo-Probe or the Hohl manipulator.
• Primary endpoints included time for colpotomy, time from skin incision to uterine detachment, and histologic assessment of vaginal thermal damage.

Main Results:

• Ninety-one patients were analyzed; 49 in the Hohl group and 42 in the Colpo-Probe group.
• The Hohl manipulator group demonstrated significantly shorter median times for manipulator insertion, skin incision to uterine detachment, and colpotomy.
• No significant difference was found in the median maximum thermal damage to the vagina between the two groups.

Conclusions:

• The Hohl manipulator is associated with reduced operative time during TLH.
• Shorter colpotomy times with the Hohl manipulator did not correlate with decreased thermal damage to the vaginal cuff.
• Further comparative studies are needed to identify optimal uterine manipulators for surgical efficiency and minimized thermal spread.