Randomized clinical trial comparing cold knife conization of the cervix with and without lateral hemostatic sutures

• Cold knife conization of the cervix is a safe procedure when performed without lateral hemostatic sutures.
• Perform this procedure without paracervical sutures does not increase the intraoperative bleeding.
• Lateral Haemostatic Sutures does not avoid intraoperative bleeding.

ObjectiveCompare blood loss during cold knife conization of the cervix with and without lateral hemostatic sutures in the cervical branches of the uterine arteries.DesignRandomized clinical trial.SettingHospital de Clínicas de Porto Alegre (HCPA).Population102 patients that underwent cold knife conization.MethodsWomen that underwent cold knife conization of the cervix were randomized to undergo the procedure with or without lateral hemostatic sutures.Main outcome measuresPrimary outcome measure: blood loss measured in grams. Secondary outcome measures: operative time and postoperative intervention. Only the participants were blinded to group assignment.ResultsFrom March 2009 to August 2012, patients were randomly assigned to one of the study groups. There were no differences in amount of blood loss between patients that underwent the procedure with and without sutures (p = 0.39). Operative time was shorter in the group without suture (p = 0.020). There were no differences in intervention due to bleeding (p = 0.20). Blood loss was greater among menstruating women than for menopausal women (p = 0.011). There were no differences in amount of blood lost between smoking and nonsmoking patients (p = 0.082).ConclusionsLateral hemostatic sutures do not affect the amount of intraoperative bleeding or the number of postoperative interventions. Their use is not necessary because they result in longer operative time, have a higher cost due to the use of suture material and pose the risk of ureter lesion in case the sutures are not placed at a lower position in the cervix.ClinicalTrials.gov IdentifierNCT02184975.