Association of Uterine Artery Ligation at Its Origin With Reduced Early Postoperative White Blood Cell Count Changes After Robotic Hysterectomy

초록

Background: Uterine artery ligation (UAL) may reduce uterine blood flow and facilitate hemostasis during hysterectomy; however, its association with early postoperative inflammatory changes remains unclear. This study aimed to compare laboratory findings and surgical outcomes based on whether UAL was performed during robotic hysterectomy (RH).Methods: We retrospectively reviewed patients who underwent RH using the da Vinci Xi, da Vinci SP, or da Vinci 5 system at Korea University Anam Hospital between January 2022 and July 2025. Patients were divided into a UAL group and a non-UAL group according to whether UAL was performed using Hem-o-Lok (R) clips (Teleflex Medical) at the uterine artery origin. Postoperative white blood cell (WBC) change was further assessed using the WBC ratio (postoperative day 1 [POD 1] WBC/preoperative WBC), analyzed both as a continuous variable and categorically using an exploratory threshold of 1.3 for logistic regression analysis. Statistical analyses were performed using Student's t-test, the chi-square test, and logistic regression analysis.Results: Among 354 patients, 146 were classified into the UAL group and 208 into the non-UAL group. Surgical time was significantly longer in the UAL group than in the non-UAL group (p < 0.001). However, pericervical bipolar coagulation time and postoperative WBC change were significantly lower in the UAL group (p = 0.017 and p < 0.001, respectively). On multivariate logistic regression analysis, UAL was independently associated with a reduced risk of greater postoperative WBC change (adjusted odds ratio [OR], 0.25; p < 0.001).Conclusions: Hem-o-Lok (R)-assisted UAL during RH was associated with reduced early postoperative WBC elevation and shorter bipolar coagulation time, suggesting a potential benefit in attenuating the early postoperative inflammatory response.

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