You are here

  • Home
  • Online First
  • Gynecologic oncology surgery maneuvers applied to reduce blood loss in laparoscopic myomectomy: description of the technique in 10 steps

Article Text

Article menu

Download PDFPDF

Video article
Gynecologic oncology surgery maneuvers applied to reduce blood loss in laparoscopic myomectomy: description of the technique in 10 steps
Free
  1. Enrique Chacon1,
  2. I Perez-Palacio2,
  3. J Gonzalez de Canales2,
  4. Nabil Manzour3,
  5. Jose Angel Minguez4 and
  6. Luis Chiva3
    1. 1Department of Gynecologic Oncology, Universidad de Navarra, Pamplona, Spain
    2. 2Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
    3. 3Clinica Universidad de Navarra Departamento de Ginecologia y Obstetricia, Pamplona, Spain
    4. 4Department of Gynecology, Clinica Universitaria de Navarra, Pamplona, Spain
    1. Correspondence to Dr Enrique Chacon; echaconc{at}unav.es

    https://doi.org/10.1136/ijgc-2024-005750

    Statistics from Altmetric.com

      Request Permissions

      If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

      Uterine myoma is the most common disease of the female genital tract in any age group.1 Although hysterectomy is the definitive surgical treatment for symptomatic myomas, myomectomy is the treatment of choice for women who want to preserve their uterus and fertility. Laparoscopic myomectomy offers minimal post-operative discomfort, a shorter hospital stay, faster recovery, and fewer surgical complications. However, a minimally invasive approach, especially in the case of multiple myomas, can result in excessive blood loss and prolonged operating time.2

      The main supply to the uterus comes from the uterine arteries, with additional contributions from the ovarian arteries. The uterine artery is a branch of the internal iliac artery. It goes through the cardinal ligament and ascends through the broad ligament at both sides of the uterus, giving the arcuate arteries that penetrate the myometrium and endometrium, branching into the radial arteries. The transient clamping of the uterine arteries may reduce the amount of bleeding by decreasing blood flow and pressure over the uterus, improving hemostasis and coagulation.3

      Figure 1
      Figure 1

      Transient clamping of the left uterine artery.

      In the present study, we show a series of surgical maneuvers in gynecological oncology applied to laparoscopic myomectomy with the aim of reducing blood loss. These techniques are based on three principles: retroperitoneal pelvic dissection performed in the context of radical hysterectomy; soft clamping of the uterine arteries and utero-ovarian vessels performed in the context of oncovascular surgery; and the use of indocyanine green to verify the correct perfusion of uterine tissues after myomectomy.4 5

      In a very systematic and methodical way the technique is described, following 10 steps. For that purpose, we will use a set of surgical videos in patients under 35 years of age with several symptomatic fibroids under 10 cm in size.

      1. Evaluation of the pelvic cavity.

      2. Retroperitoneal dissection.

      3. Bilateral clamping of the utero-ovarian vessels.

      4. Bilateral clamping of the uterine artery.

      5. Local infiltration with lidocaine and epinephrine.

      6. Enucleation of the myoma.

      7. Closure of the uterine defect.

      8. Removal of the vascular clamps.

      9. Posterior colpotomy and evacuation of the myoma.

      10. Indocyanine green angiography to assess uterine perfusion.

      Video 1 Description of the technique in ten steps

      Data availability statement

      All data relevant to the study are included in the article.

      Ethics statements

      Patient consent for publication

      References

      1. ↵
        1. Kongnyuy EJ,
        2. Wiysonge CS
        . Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2014. doi:10.1002/14651858.CD005355.pub5
      2. ↵
        1. Liu L,
        2. Li Y,
        3. Xu H, et al
        . Laparoscopic transient uterine artery occlusion and myomectomy for symptomatic uterine myoma. Fertil Steril 2011;95:254–8. doi:10.1016/j.fertnstert.2010.05.006
        OpenUrlCrossRefPubMed
      3. ↵
        1. Moratalla-Bartolomé E,
        2. Lázaro-de-la-Fuente J,
        3. López-Carrasco I, et al
        . Surgical impact of bilateral transient occlusion of uterine and utero-ovarian arteries during laparoscopic myomectomy. Sci Rep 2024;14. doi:10.1038/S41598-024-57720-9
      4. ↵
        1. Jurado M,
        2. Chiva L,
        3. Tinelli G, et al
        . The role of oncovascular surgery in gynecologic oncology surgery. Int J Gynecol Cancer 2022;32. doi:10.1136/IJGC-2021-003129
      5. ↵
        1. Escobar PF,
        2. Ramirez PT,
        3. Garcia Ocasio RE, et al
        . Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy. Gynecol Oncol 2016;143:357–61. doi:10.1016/J.YGYNO.2016.08.239
        OpenUrlPubMed

      Footnotes

      • X @Quique_ChC

      • Contributors This article was a collaborative effort involving six researchers. The principal investigator, EC, led the conception, design, and execution of the study. All authors, including EC, contributed equally to the development of the surgical technique, data collection, analysis, manuscript drafting, and critical revision. Each author provided valuable insights and expertise in their respective areas throughout the research process. All authors have reviewed and approved the final version of the manuscript. EC is the author acting as guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.