Fertility and sterility · 2019
Uterine artery occlusion at myomectomy.
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Zakhari Andrew, Sanders Ari P, Murji Ally
Аннотация
OBJECTIVE: To demonstrate three approaches to uterine artery occlusion at time of myomectomy as a blood-sparing intraoperative technique.
DESIGN: A step-by-step explanation of the procedure with surgical video footage.
SETTING: Academic medical center.
PATIENT(S): Patients undergoing laparoscopic myomectomy, for whom a uterine artery occlusion was performed before any uterine incision.
INTERVENTION(S): A step-wise approach is applied before beginning the myomectomy portion of the procedure, which includes the following: [1] selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) on the basis of individual anatomy; [2] identification of relevant anatomy and important landmarks for the procedure; [3] isolating the uterine artery and identifying the ureter; [4] occluding the uterine artery.
MAIN OUTCOME MEASURE(S): Successful identification of the ureter and uterine artery, and occlusion of the latter by surgical clipping.
RESULT(S): In all cases, the uterine artery was clearly identified, as was the ureter, and surgical clips were placed, resulting in successful uterine artery occlusion.
CONCLUSION(S): Uterine artery occlusion can be performed by three different approaches, as have been demonstrated in this video. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.
DESIGN: A step-by-step explanation of the procedure with surgical video footage.
SETTING: Academic medical center.
PATIENT(S): Patients undergoing laparoscopic myomectomy, for whom a uterine artery occlusion was performed before any uterine incision.
INTERVENTION(S): A step-wise approach is applied before beginning the myomectomy portion of the procedure, which includes the following: [1] selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) on the basis of individual anatomy; [2] identification of relevant anatomy and important landmarks for the procedure; [3] isolating the uterine artery and identifying the ureter; [4] occluding the uterine artery.
MAIN OUTCOME MEASURE(S): Successful identification of the ureter and uterine artery, and occlusion of the latter by surgical clipping.
RESULT(S): In all cases, the uterine artery was clearly identified, as was the ureter, and surgical clips were placed, resulting in successful uterine artery occlusion.
CONCLUSION(S): Uterine artery occlusion can be performed by three different approaches, as have been demonstrated in this video. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.