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Minimally Invasive Myomectomy with Temporary Bilateral Uterine Artery Blockage at Anterior Cul-de-Sac
Pengfei Wang1,2, Lucia Di Francesco2, Valmiki Seeraj1,2
1Department of Obstetrics and Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. (Dr. Wang, Seeraj, and Mehdizadeh).
Background And Objectives:
Minimizing intraoperative bleeding is pivotal in myomectomy, and blockage of uterine arteries has been reported as an effective approach. We developed a novel technique to temporary occlude bilateral uterine arteries at the anterior cul-de-sac in minimally invasive myomectomy (MIS), including minilaparotomy, laparoscopic-assisted myomectomy, and laparoscopic myomectomy. This study aims to evaluate the intraoperative and postoperative outcomes of this technique in complicated myomectomy cases.
Methods:
Twenty-seven patients underwent minimally invasive myomectomy by single minimally invasive surgeon using bilateral uterine arteries blockage. To match the complexity of myomectomy, 66 open cases performed by generalists were used for control.
Results:
There were no significant differences in fibroid size, number, or weight between MIS and open myomectomy groups. For intraoperative outcomes, the MIS group showed longer operative time (271.3 ± 72.9 vs 179.9 ± 78.8 minutes, P < .05), but fewer cases of intraoperative blood transfusion (3% vs 17%, P < .05) and fewer intraoperative complications (0% vs 3%, P < .005). For postoperative outcomes, the MIS group demonstrated shorter hospital stay (70% vs 29% for 0-1 day; 11% vs 42% for 2 days; 19% vs 29% for 3 or more days, P < .05) and fewer postoperative complications (3% vs 9%, P < .05).
Conclusion:
Temporary blockage bilateral uterine arteries enable the safe performance of complicated myomectomy via minimally invasive surgery.
