LIGATURE OF THE HYPOGASTRIC ARTERY IN ADVANCED CERVICAL CANCER-DESCRIPTION OF TECHNIQUE, ANATOMICAL REMARKS AND APPLICATION IN GYNECOLOGIC ONCOLOGY

Abstract
The ligature of hypogastric artery by laparotomy is the well defined technique to stop bleeding in gynecology and obstetrics. The ligature is useful during operation of gynecologic cancers and to assure immediate hemostasis when the complication of postoperative bleeding occur. In advanced cervical cancer the persistent bleeding may require embolization or ligature of the hypogastric artery. In many oncological centers the embolization of hypogastric artery is the preferred method. The laparoscopic ligature remains an alternative option. We have developed our own technique with the use of roticulator and extracorporeal knots. The surgical approach have the advantage to give the possibility of occlusion of the ovarian arteries and round ligaments, which increase the effectiveness of this procedure.

Key words
Ligature of hypogastric artery, laparoscopy, advanced cervical cancer

Bibliografía del artículo

1. Evans S, McShane P, The efficacy of internal iliac artery ligation in obstetric hemorrhage, Surg Gynecol Obstet 1985;160:250-3.
2. DiSaia P, Creasman W, Complications of disease and therapy. In DiSaia P, Creasman W. editors. Clinical gynecologic oncology. St Louis: Mosby 1993:643-7.
3. Kamina P, Les arteres. In Anatomie gynecologique et obstetricale. 1984 editeur maloine. 117-118.
4. Sobiczewski P, Bidzinski M, Derlatka P, Laparoscopic ligature of the hypogastric artery in the case of bleeding in advanced cervical cancer-case report, Gynecol. Oncol 2002; 84,344-348.
5. Hansch E, Chitkara U, McAlpine J, El-Sayed Y et al. Pelvic arterial embolization for control of obstetric hemorrhage: a five year experience. Am. J. Obstet. Gynecol 1999; 180:1454-60.
6. Grischin GL, Drosdovskij BJ, Karjakin OB, Pokorny L, Kelemen J. Transcatheter embolization of the hypogastric artery in patients with tumors of the bladder and uterus Roentgenblatter 1986;39:323-7.
7. Gassibe EF, Gassibe E. Laparoscopic ligation of hypogastric arteries using the Hulka clip to arrest massive bleeding due to stage IIb cervical carcinoma, J. Am. Assoc. Gynecol. Laparosc. 1997;4:259-61.
8. Hald K, Istre O, Langebrekke A. Occlusion of a uterine for treatment of symptomatic leiomyomata abstract 10 Congress of the ESGE Lisbon, Portugal 21-24 November, 2001 page 71.
9. Skret A, Obrzut B, Stachurski J. Laparoscopic ligature of iliac arteries in the treatment of hemorrhage related to uterine cervical cancer. Ginekol. Pol. 1994; 65:527-30.
10. Istre O, Hald K, Langebrekke A. Laparoscopic occlusion of uterine artery for treatment of symptomatic leiomyomata; abstract 10 Congress of the ESGE Lisbon, Portugal 21-24 November, 2001 page 69.