The Use of Uterine Manipulator versus Myoma Screw in Total Laparoscopic Hysterectomy

Background: Laparoscopic hysterectomy was performed many years ago and gaining widespread acceptance as alternatives to standard abdominal hysterectomy from far years onwards. Objective: To compare between the use of uterine manipulator (UM) versus myoma screw (MS) in TLH regarding to safety, cost and the operative time. Patients and methods: The study enrolled 60 patients in two groups: Group (I) 30 patients underwent total laparoscopic hysterectomy (TLH) using UM, while Group (II) 30 patients underwent TLH using MS and patients were randomly assigned to one of the two approaches. Results: Endometrial hyperplasia was the most common indication for both types of surgeries. There was a statistically significant difference between both groups regarding operative time as it was (105.5±11.5 minutes versus 88.4±7.6 minutes) for group (I) vs (II) respectively, (P<0.001). There was a statistically significant difference between both groups regarding blood loss during operation as it was (116.7 ±65.8 ml versus 78.8±15.5ml) for group (I) vs (II) respectively (P<0.001), as they much lower in Myoma screw group (II). For intra-operative complications in uterine manipulator group (I), we had two cases of cervical tear, a case of vaginal laceration and a case of uterine perforation versus a case of bad oxygen saturation in MS group (II). Conclusion: The use of MS in TLH had less operative time and hence less morbidity, less intraoperative blood loss, less post- operative pain and early recovery, than the use of UM. The TLH using MS and the TLH using UM could be a good option for hysterectomy if no contraindications.