Page 21 - Laparoscopic Journal - WJOLS

WJOLS

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy
The exact mechanisms by which the uterine artery menstruation problems, mostly menorrhagia and/or
ligation causes the reduction in the size of myoma have lower abdominal pain. None of the patients was preg-
not been established, yet cell apoptosis and necroses nant at the time of the study nor had amenorrhea. The
1
have been noted as possible explanations. Noting these patients were divided into two groups. Group A (n = 65),
reported benefits, laparoscopic ligation of the uterine the experimental group, consisted of patients who under-
vessels, which causes fewer complications than other went both LUAL and myomectomy. Group B (n = 87), the
procedures, may be a better alternative to hysterectomy, control group, included patients who were treated with
despite the higher technical skill required to perform laparoscopic myomectomy alone. Both groups had simi-

this procedure. 11 lar overall general characteristics inclu ding age, mean
Many studies in past evaluated the effect of combined average size of myomas, and the number of myomas.
laparoscopic uterine artery ligation (LUAL) and myomec- For a period of 24 months, all of the patients were
tomy as a therapeutic method in decreasing operative evaluated every 3 months to assess their symptoms and
morbidities, such as intraoperative hemorrhage, operation check for the recurrence of myomas by transvaginal
time, and postoperative fever. ultra sound. Patients graded their subjective symptomatic
Some of the studies also evaluated myoma recurrence changes in terms of pain and bleeding using one of two
and symptom alleviation associated with recurrence as choices: completely resolved or unchanged. Menorrhagia
well as the fertility outcomes for relevant participants. improvement was evaluated by the pads used during
menstruation, and dysmenorrhea improvement was
AiM evaluated by the amount of analgesics used.
The average operating time and blood loss were 112 ±
To determine the impact of uterine artery ligation in
laparoscopic myomectomy, according to surgical results 18 minutes and 173 ± 91 ml for the experimental group
and clinical outcomes. and 95 ± 14 minutes and 402 ± 131 ml for the control
group, respectively (statistically significant). A total of
MATERiALS AnD METHoDS 15 (17.2%) of the control group patients required a blood
transfusion, but none of the experimental group patients
A review of literature was performed in September 2015 required one. Febrile morbidity occurred in 18.5% of the
using search engines: Highwire Press, Pubmed and experimental group and 20.7% of the control group. In
Google. The searches used the keyword ‘laparoscopic the experimental group, the recurrence of myoma was 6.2
myomectomy with uterine artery ligation’. No statis tical and 98.1% of the patients reported symptoms improve-
analyses have been performed. Data extraction was ment; however, in the control group, these figures were
directly by full text of the publications in the Journals. 20.75 and 83.1%, respectively (statistically significant).
In most of the studies main outcome measured was The pregnancy rates were not statistically significantly
operating time, blood loss, blood transfusion, febrile different in the experimental group (35%) and the control
morbidity, symptoms improvement, recurrence rate, and group (35.7%).
pregnancy rate. There were several studies performed A study by Chin-Jung Wang et al 20 consecutive
in past on this topic. And in most of the studies uterine women with symptomatic uterine fibroids desiring to
artery ligated at it origin. preserve the uteri underwent laparoscopic surgery with
ligation of the uterine arteries with ligating clips, followed
RESULTS
by myomectomy and removal of the clips.
A study by Saeed Alborzi et al of 152 women with symp- Laparoscopic uterine artery ligation with reversible
tomatic uterine myomas necessitating surgical inter- ligating clips was successfully performed in all patients.
vention who wished to retain their uteri, 65 underwent The median main fibroid diameter and fibroid weight were
laparoscopic uterine artery ligation and myomectomy 7.3 cm [interquartile range (IQR) 7.0–9.0] and 210 gm (IQR
(experimental group) and 87 received laparoscopic 150–295 gm), respectively. The median operating time
myomectomy only (control group). All the participants was 120 minutes (IQR 100–148 minutes) and blood loss
were recruited from women with symptomatic myomas was 100.0 ml (IQR 56.3–137.5 ml). The median number of
during a 3-year period between 2003 and 2005. All the fibroids removed was one (IQR 1–4.3). The median post-
symptomatic myomas were diagnosed by transvaginal operative hospital stay was 3 days (IQR 2–3 days) and
ultrasound or sonohysterography. All of the women no patient developed complications. Menstrual bleeding
wished to retain their uteri. In total, 152 women between problems and bulk-related symptoms were controlled
the ages of 20 and 46 years, who could be followed up for in 90.0 and 100% of women, respectively after 6 months
2 years, were selected. The women’s symptoms included of follow-up. One woman conceived spontaneously
World Journal of Laparoscopic Surgery, May-August 2015;8(2):52-56 53