LAUSR

Dear Editor, Li et al. reported a new uterine compression suture (UCS), removable retropubic uterine compression suture (RRUCS). Two concepts characterize it: (i) the uterus is compressed against the public bone and abdominal wall, and importantly, (ii) the threads should/can be removed. Although, as Li et al. cited, I was the first to report the concept of “removable UCS,” I did not perform it. Li et al. actually did so. Respectfully, I have some questions. A PubMed search with “Li uterine compression suture” yielded 12 papers. They described at least eight different UCS (2015–2021), with some procedural differences, with none overlapping. Some procedures were designed to achieve hemostasis of the lower-uterine-segment bleeding. However, there were some similarities: the abovementioned two key concepts were similar among some recently published UCS of Li. I wish to know which of the eight they finally recommend for hemostasis of postpartum hemorrhage in general. Although Li0s various UCS procedures did not overlap, the time in which they performed different UCS overlapped. For example, in 2010 they performed at least five different UCS. More than 20 years were required for us to establish Matsubara-Yano (MY) UCS, and some procedures have changed: we initially made three longitudinal sutures but we recognized that two longitudinal sutures may be sufficient. As such, surgeons usually employ one procedure and then another in a trial-and-error manner, finally establishing a new procedure. Let us assume that procedures X, Y, and Z were performed in 2018, 2019, and 2020, respectively; this may be natural. We rarely perform X, Y, and Z at the same time, 2018–2020. This is because the procedure “considered the best at that moment” should be employed in each patient. I wish to know the situation in which several UCS were performed at the same time. Not every reader may grasp all UCS that Li et al. hitherto reported. Less-experienced obstetricians may jump to the previously reported (possibly out-of-date) UCS of Li, not knowing the recent RRUCS. Thus, is RRUCS the best? Is the latest the best? I believe that procedure-founders should frankly state that some previously reported procedures may have some pitfalls and thus another newer one should be used, if the situation is so. This holds true for medical research in general, and is not confined to the research of a new procedure. I would never criticize the work of Li et al, and only wish to know their viewpoint.