LAPAROSCOPIC MYOMECTOMY FOR TEMPORARY UTERINE ARTERY OCCLUSION


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Abstract

Objective. To evaluate the efficiency of temporary clipping of the uterine arteries, the vessels of infundibulopelvic ligaments and round ligaments of the uterus during laparoscopic myomectomy. Subjects and methods. The case-control study included 26 women who had (Group 1, n = 13) and had not (Group 2; n = 13) undergone temporary clipping of the uterine arteries and the vessels of infundibulopelvic ligaments and round ligaments of the uterus to reduce blood loss at laparoscopic myomectomy. Total surgical duration, clipping time, myomectomy time, ischemia duration, blood loss volume, the number and size of removed nodules were compared. Results. The two groups showed a significant difference when comparing uterine sizes during bimanual examination (12.3+2.1 weeks in Group 1; 16+2.3 weeks in Group 2; p = 0.0006) and intraoperative blood loss (170.7+181.7 ml in Group 1; 884.6+387.5 ml in Group 2;p = ft 000002). The number of removed myomatous nodules was not more than 6 in both groups and averaged 2+1.8 and 1.7+1.3 in Groups 1 and 2, respectively. There were no differences in total surgical duration (144.6±31.5 min in Group 1 and 143.4±50.2 min in Group 2); the duration of clipping was 31.1±8.9 min; that of myomectomy during temporary vessel clipping was 2 times shorter (55.3±19.7 min (p = 0.001)). Examination of hemoglobin levels on day 3 postsurgery revealed their more considerable decrease in Group 2 (5.3±8.3 g/l in Group 1; 14.6±13.2 g/l in Group 2; p = 0.07). No intraoperative or early postoperative complications, including wounds to the ureters, iliac vessels, and intestine, were recorded. Conclusion. According to the results of the pilot study, temporary clipping of the uterine arteries, the vessels of infundibulopelvic ligaments and round ligaments of the uterus is an effective procedure to reduce intraoperative blood loss at laparoscopic myomectomy; however, it must be used by a specialist having surgical skills in the retroperitoneal space of the small pelvis.

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About the authors

Maya V. Sannikova

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: m_sannikova@oparina4.ru
PhD, researcher at the Department of combined and integrated methods of treatment of gynecological diseases Moscow 117997, Ac. Oparina str. 4, Russia

Gregory N. Khabas

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: g_khabas@oparina4.ru
MD, Ph.D., head of the Department of combined and integrated methods of treatment of gynecological diseases Moscow 117997, Ac. Oparina str. 4, Russia

Anna Semyonovna Makarova

I.M. Sechenov Ist MSMU

clinical resident 119991, Russia, Moscow, Bolshaya Pirogovskaya str. 2 bid. 4

Dmitry Leonidovich Ovodenko

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: d_ovodenko@oparina4.ru
PhD, oncogynecologist, Department of combined and integrated methods of treatment of gynecological diseases Moscow 117997, Ac. Oparina str. 4, Russia

Dmitri Nikolaevich Kushlinsky

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: d_kushlinskiy@oparina4.ru
oncogynecologist, Department of combined and integrated methods of treatment of gynecological diseases Moscow 117997, Ac. Oparina str. 4, Russia

Alexey Aleksandrovich Korshunov

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_korshunov@oparina4.ru
obstetrician-gynecologist, Department of combined and integrated methods of treatment of gynecological diseases Moscow 117997, Ac. Oparina str. 4, Russia

Leila V. Adamyan

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: l_adamyan@oparina4.ru
Professor, MD, PhD, Academician of Russian Academy of Sciences, Head of the Department of Operative Gynecology, Deputy Director for Science Moscow 117997, Ac. Oparina str. 4, Russia

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