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WJOLS

A Comparison of Combined Laparoscopic Uterine Artery Ligation and Myomectomy vs Laparoscopic Myomectomy

Table 1: Comparison of various studies in term of operative time and intraoperative blood loss
Outcome Intraoperative
No. of participants Operating time (min) blood loss (ml)
Control
Experimental Control Experimental group Experimental Control
Study name group (E) group (C) Total group (E) (C) group (E) group (C)
Saeed Alborzi et al 65 87 152 112 ± 18 95 ± 14 173 ± 91 402 ± 131
Chin-Jung Wang et al 20 — 20 120 (100–148) — 100 (56.3-137.5) —
Ji Hae Bae et al 51 39 90 100 ± 33.8 90 ± 37.1 72.3 ± 109 62.6 ± 77.3
Z Holub et al 15 16 31 76.5 69.6 93.7 134
Giuseppe Vercellino 80 86 166 — — 1.2 g/dl 1.45 g/dl
et al
E: Experimental group, C: Control group
are permanent methods and might not be suitable for In experimental group there is decrease in incidence
women who want to retain their childbearing capacity. of recurrence rate of myoma and blood transfusion com-
Hem-o-lok clips can stop uterine blood flow at the uterine pared to contol group.
artery level and reperfusion occurs after removal. With
the aid of this instrument, blood loss can be controlled ConCLUSion
and childbearing preserved when performing a uterine
depletion procedure followed by a myomectomy. In conclusion, LM offers several benefits to the patient. It
Criticisms of the transient blocking uterine perfu- is still a challenging technical procedure and might be
associated with high surgical morbidity and incidence
sion procedure are that the average 2 hours occlusion
time might induce irreversible damage in the uterine of blood transfusion. Surgical strategies are needed to
myometrium and cause embolic events and pulmonary overcome these problems in LM.
Uterine artery ligation prior to myomectomy can

emboli after release of the clips. control operative blood loss in LM and preserve the
Traditional uterine tourniquets usually require only childbearing capacity of the patient, However, larger
22
an hour. A review of the literature on ischemic, necrotic studies to investigate the feasibility and effectiveness of
twisted adnexa showed no reports of embolic pheno- this procedure are crucial before definite conclusions can
mena after detorsion. 23,24 In addition, the uterus has a be drawn.
dual extrinsic blood supply. The primary supply is from
the uterine arteries, and the secondary supply is from REFEREnCES
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rian arteries remain intact during the operation, damage and myomectomy via minilaparatomy in the treatment of
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World Journal of Laparoscopic Surgery, May-August 2015;8(2):52-56 55