Comparative study of the efficacy of the Songkla uterine manipulator and the Hulka controlling tenaculum in laparoscopic tubal ligation.

Objective: To compare the efficacy of the Songkla uterine manipulator (SUM) and the Hulka controlling tenaculum for manipulation of the uterus for laparoscopy.

Method: Forty women scheduled for laparoscopic tubal ligation were randomized to the SUM group (n=20) or the Hulka group (n=20) as uterine manipulator. Laparoscopic evidence of antevertion and lateral uterine movements and organ exposure was video recorded. Assessment of organ exposure and degree of lateral uterine deviation were subsequently evaluated.

Results: The characteristics of the women were similar in both groups. Right, left and range of lateral uterine motion were greater in the SUM group than the Hulka group (59 vs 42 degrees, 60 vs 47 degrees, and 118 vs 89 degrees, respectively, p<0.0001). The SUM group had 2.4 times better cul-de-sac exposure than the Hulka controlling tenaculum (95% CI: 0.51-11.51, p= 0.475). The SUM exposed fallopian tubes better than the Hulka tenaculum (p=0.022) but other structures were not significantly better visualized. There were no complications in the SUM group but two had cervical bleeding in the Hulka group.

Conclusion: The SUM has advantages over the Hulka controlling tenaculum in giving a wider angle of lateral uterine deviation and better exposure of the fallopian tubes.