Efficacy of medical and surgical interventions to reduce blood loss during laparoscopic myomectomy: A systematic review and meta-analysis.

OBJECTIVES

To compare the effectiveness of different medical and surgical interventions to reduce blood loss in milliliters during laparoscopic myomectomy and to assess the total operative time, as well as the need for conversion to hysterectomy or laparotomy.

SEARCH STRATEGY: An exhaustive search was conducted across the following databases, MEDLINE, EMBASE, PubMed, Web of Science and Scopus, from the first year available until May 2022. Terms used were myomectomy, fibroid, fibroid resection, laparoscopy, endoscopy, gynecologic endoscopy, blood loss, hemorrhage, and transfusion.

SELECTION CRITERIA: Randomized controlled trials involving patients with uterine myomatosis who underwent laparoscopic myomectomy and received either a specific pharmacologic or surgical intervention to reduce blood loss, compared with another intervention or placebo, were included.

DATA COLLECTION AND ANALYSIS: Data extraction was performed by two authors using a previously designed form. Effect sizes for each treatment comparison reported were calculated as mean differences, and a frequentist network meta-analysis was performed for the outcome of serum hemoglobin levels using the control group as the comparator.

MAIN

RESULTS

A total of 23 studies were included for the quantitative synthesis, with 2152 women. The combination of bupivacaine with epinephrine showed the most beneficial effect on hemoglobin decrease (in mg/dL) in the network meta-analysis. Among the mechanical measures, the temporary uterine artery ligation with or without ovarian vessel ligation demonstrated the greatest reduction in blood loss (mean difference [MD] -122.61, 95% confidence interval [CI] -156.3 to -88.49; MD -95.14, 95% CI -113.17 to -77.10, with or without ligation, respectively).

CONCLUSIONS

Different interventions can reduce blood loss during laparoscopic myomectomy, the most effective were epinephrine plus bupivacaine and temporary uterine artery ligation. Using them is critical for minimizing complications during the procedure and so allowing fertility preservation. However, further randomized controlled trials are required to safely establish clinical recommendations.

CLINICAL REGISTRATION: Prospective Registry of Systematic Reviews (PROSPERO) ID: CRD42022324210.