Uterine artery occlusion at myomectomy

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Authors:

Andrew Zakhari, M.D., Ari P. Sanders, M.D., Ally Murji, M.D., M.P.H.

Abstract:

Objective

To demonstrate three approaches to uterine artery occlusion at time of myomectomy as a blood-sparing intraoperative technique.

Design

A step-by-step explanation of the procedure with surgical video footage.

Setting

Academic medical center.

Patient(s)

Patients undergoing laparoscopic myomectomy, for whom a uterine artery occlusion was performed before any uterine incision.

Intervention(s)

A step-wise approach is applied before beginning the myomectomy portion of the procedure, which includes the following: [1] selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) on the basis of individual anatomy; [2] identification of relevant anatomy and important landmarks for the procedure; [3] isolating the uterine artery and identifying the ureter; [4] occluding the uterine artery.

Main Outcome Measure(s)

Successful identification of the ureter and uterine artery, and occlusion of the latter by surgical clipping.

Result(s)

In all cases, the uterine artery was clearly identified, as was the ureter, and surgical clips were placed, resulting in successful uterine artery occlusion.

Conclusion(s)

Uterine artery occlusion can be performed by three different approaches, as have been demonstrated in this video. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.


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