From the Research
During a hysterectomy, uterine arteries should be clamped at their origin from the internal iliac artery, as this approach has been shown to minimize blood loss and reduce the risk of complications such as ureteral injury or excessive bleeding 1. This location allows for precise ligation of the uterine arteries, which provide the main blood supply to the uterus, carrying approximately 90% of the uterine blood flow.
The procedure involves identifying the avascular space in the broad ligament, then carefully isolating, clamping, cutting, and ligating the uterine vessels at their origin from the internal iliac artery. This approach is supported by recent studies, including a 2020 study published in the Journal of Minimally Invasive Gynecology, which demonstrated the feasibility and safety of total laparoscopic hysterectomy with uterine artery ligation at the origin 1.
Other studies have also highlighted the importance of careful dissection and ligation of the uterine arteries to minimize blood loss and prevent complications. For example, a 2017 study published in Orvosi Hetilap found that coagulation of the uterine arteries at their origin during total laparoscopic hysterectomy resulted in minimal blood loss and a low complication rate 2.
In contrast, older studies, such as a 1991 study published in Revue Francaise de Gynecologie et d'Obstetrique, suggested ligating the uterine arteries at a different location, but these studies are less relevant to current practice 3.
Overall, the evidence suggests that clamping the uterine arteries at their origin from the internal iliac artery is the most effective and safe approach during a hysterectomy, and this technique should be prioritized to minimize morbidity, mortality, and improve quality of life. Key points to consider include:
- Identifying the avascular space in the broad ligament
- Carefully isolating, clamping, cutting, and ligating the uterine vessels at their origin from the internal iliac artery
- Using a standardized approach to minimize blood loss and prevent complications
- Considering the patient's individual anatomy and surgical history when planning the procedure.