Abstract

Objective: To delineate the procedure of temporary blockage of the uterine arteries on uterus at the cervical level in myomectomy.

Design: Educational video.

Setting: Teaching community hospital and tertiary referral center

Intervention: The technology was demonstrated in a laparoscopic myomectomy case, but the same technology can be applied to mini-laparotomy for myomectomy or laparoscopic assisted myomectomy (LAM). After normal setup and trocar placement for laparoscopic surgery, an extra 12 mm trocar was placed at 2 cm above the suprapubic symphysis. The uterine manipulator was also placed to delineate the uterine-vesicle fold. The procedure was started on the right side. First, a peritoneal membrane incision was made from uterine-vesicle fold towards round ligament. With millimeter-by-millimeter dissection, the right uterine artery was then exposed, skeletonized and was temporarily occluded with a laparoscopic bull dog clamp. Similarly, the procedure was carried out on the left side. Subsequentially, laparoscopic myomectomy was conducted, following the normal fashion. Finally, the suprapubic incision was extended to 2-3 cm and a small auto-retractor was applied to open the incision. All specimens were placed into an Endo-bag and removed with contained morcellation.

Main Outcome Measures: Not applicable.

Results: The entire operative time for the demonstrated case was 200 minutes. The estimated intraoperative blood loss was 100cc. The specimen weighted 830 gram and the patient was discharged on postoperative day 1.

Conclusion: Temporary uterine artery occlusion is one of the most effective modalities to minimize bleeding, especially for minimally invasive myomectomy in challenging cases. Dissection and blockage of the uterine arteries on the uterus at the cervical level is an excellent alternative when the uterus is very large and the arteries are difficult to access by other approaches.

Keywords

Myomectomy; Uterine artery; Bull dog clamp; Laparoscopy; Min-laparotomy; Laparoscopic assisted myomectomy (LAM)

Introduction