Comparison of simple uterine manipulator-injector (SUMI) with the Cohen cannula in gynecologic laparoscopy

Abstract

Objective: To assess the effectiveness and safety of using simple uterine manipulator injector (SUMI) compared to Cohen cannula in laparoscopy. Design: A Pilot randomized trial, incorporating 40 patients randomized into Group I or SUMI (n = 22) and Group II or Cohen cannula (n = 18). Setting: Ain Shams Maternity Hospital, Cairo, Egypt. Material and methods: Forty patients with infertility planned to undergo laparoscopy. The assigned uterine cannula was applied according to defined rules, followed by laparoscopy. Main outcome measures were application and removal time, uterine maneuverability in sagittal and coronal planes, easiness of insertion and manipulation, dye injection and its leakage, abandonment of the use of cannula, and adverse effect or complication. Results: Application time was longer with SUMI (3.8 ± 1.3 vs. 1.3 ± 1.1 min, P < 0.001). The range of uterine maneuverability had wider angles with SUMI, both in sagittal (77.7 ± 12.7 vs. 47.2 ± 21.9, P < 0.001) and coronal (139.6 ± 30.4 vs. 89.4 ± 22.4, P < 0.001) plains. The easiness of insertion, manipulation, dye injection and removal were comparable. The incidence of dye leakage was higher with SUMI (27.3% vs. 5.9%, P < 0.05), yet minimal and not affecting dye test. Cohen cannula use was abandoned due to marked limitation of uterine maneuverability in one case and due to considerable dye leakage in another. No incidents of uterine perforation or cervical laceration requiring suturing were recorded. Conclusion: Although SUMI takes longer to insert, the ease of its use is comparable with the Cohen cannula. A major advantage of its use is increased range of uterine maneuverability with better surgical field exposure.

Keywords

• Chromopertubation
• Cohen cannula
• Gynecologic laparoscopy
• Uterine cannula
• Uterine manipulator