Role of Vasopressin in Total Laparoscopic Hysterectomy - A Randomized Controlled Trial
Objective: To evaluate the use of intramyometrial vasopressin for reducing blood loss in total laparoscopic hysterectomy (TLH) in cases where the uterus is ≥ 12 weeks size. Design: A randomized controlled trial was conducted at a tertiary care center over 2.5 years. A total of 110 participants were randomized into Group A (vasopressin) and group B (normal saline) with equal arms. Materials and Methods: Group A and group B received intramyometrial injection of dilute vasopressin and normal saline, respectively. Estimated blood loss (EBL) and change in the postoperative hemoglobin were evaluated as primary outcomes. Bleeding from the pedicles and myoma spiral site were used to assess the role of vasopressin to maintain a clear surgical field. Results: The median EBL was 200 mL in group A and 250 mL in group B, the difference not being statistically significant. The mean postoperative Hb was 10.7 g/dL in group A and 10.8g/dL in group B. The occurrence of bleeding at the pedicles was comparable in both groups. There was no bleeding at the myoma spiral site in 89% of patients in the vasopressin group compared to 45% in the control group, and this difference is significant. Conclusion: There was no significant difference in the blood loss with the use of vasopressin in TLH for a uterine size of>12 weeks compared to normal saline. Vasopressin helps reduce bleeding from the myoma spiral site used for uterine manipulation.