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Vaibhav A Dunghav 10.5005/jp-journals-10033-1247
revieW articLe

A Comparison of Combined Laparoscopic Uterine Artery

Ligation and Myomectomy vs Laparoscopic Myomectomy
in Treatment of Symptomatic Myoma

Vaibhav A Dunghav

ABSTRACT Among nonsurgical interventions, hormone therapy
Uterine leiomyomas are one of the most common benign with gonadotropin-releasing hormone (GnRH) agonists
smooth muscle tumors in women, with a prevalence of 20 has been the treatment of choice, and may result in
to 40% in women over the age of 35 years. Although many symptomatic improvement and reduction in the size of
women are asymptomatic, problems, such as bleeding, pelvic the myoma. However, rapid regrowth of the myomas
1,4
pain, and infertility may necessitate treatment. Laparoscopic
myomectomy is one of the treatment options for myomas. The to their original size has been reported to cause the
major concern of myomectomy either by open method or by recurrence of symptoms within a few months after the
laparoscopy is the bleeding encountered during the proce- discontinuation of hormone treatment. Furthermore,
4
dure. Most studies have aimed at ways of reducing blood loss GnRH agonists can obliterate the myoma myometrial
during myomectomy. There are various ways in which bleeding
during laparoscopic myomectomy can be reduced, the most interface and as a result enucleation of myomas becomes
5
reliable of which is ligation of the uterine vessels bilaterally. In more difficult. As a result, hormone therapy has been
this review, we propose to discuss the benefits and possible limited to premenopausal use only.
disadvantages of ligating the uterine arteries bilaterally before Among the available modalities for surgical treat-
performing laparoscopic myomectomy.
ment of myomas, hysterectomy is the most common. In
Keywords: Fibroids, Laparoscopic myomectomy, Myomec- the United States, an estimated 600,000 hysterectomies
tomy, Uterine artery embolization, Uterine artery ligation, are performed each year, with symptomatic uterine
Uterine devascularization.
myomas cited as the main cause for approximately 30%
How to cite this article: Dunghav VA. A Comparison of Com- of all hysterectomies. For women who wish to retain their
bined Laparoscopic Uterine Artery Ligation and Myomectomy
vs Laparoscopic Myomectomy in Treatment of Symptomatic childbearing potential, abdominal myomectomy has been
Myoma. World J Lap Surg 2015;8(2):52-56. the alternative. 6
Less invasive alternatives, namely, laparoscopic and
Source of support: Nil
hysteroscopic myomectomy procedures, have also been
Conflict of interest: None
7
developed in recent years. Unfortunately, of these two
approaches, the risk of reported recurring myomas is far
inTRoDUCTion
1,4
greater with abdominal myomectomies because, in cases
Uterine myomas are the most common tumor of the with numerous myomas, the surgeon often removes the
1,2
female reproductive system among any age group. The large and easily visible myomas, unintentionally leaving
incidence of this form of tumor is reported to be between the smaller or in situ ones behind. 1,7,8 Postoperative intact
3
20 and 40% among women 35 years of age and older. myomas within the uterus may account for a persistence
Myomas can significantly decrease the quality of life for of menorrhagia and a high rate of myoma recurrence.
women as they can result in menorrhagia, dysmenor- There are also controversies regarding all types of
rhea, and pelvic pain. Large myomas can also stimulate surgical intervention. Many researchers have reported
urinary tract compression, causing increased urinary that myomectomies (abdominal or laparoscopic), espe-
frequency and urgency. cially in the case of multiple myomas, have resulted in
excessive blood loss, prolonged operating time, post-
operative complication, and a prolonged hospital stay. 7
Senior Resident To address these complications, an alternative treat-
Department of Obstetrics and Gynecology, Dr DY Patil Medical ment, the laparoscopic bilateral coagulation of uterine
9
College, Pimpri, Pune, Maharashtra, India vessels, was introduced by Liu in 2000. Other studies
Corresponding Author: Vaibhav A Dunghav, Senior Resident reported successful outcomes in treating symptomatic
Department of Obstetrics and Gynecology, Dr DY Patil myomas by uterine artery ligation that reduced the
Medical College, Pimpri, Pune, Maharashtra, India, Phone: patient’s symptoms by 60 to 80% and the size of myoma
9158872885, e-mail: vaibhav.dunghav84@gmail.com
by 40 to 50%. 10
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