Uterine artery occlusion at myomectomy.

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.