Tips and tricks: How to control bleeding in mini invasive myomectomy?

Myomectomy using laparoscopic approach offers patients reduced abdominal scars, better post surgical rehabilitation. However, bleeding control may pose a challenge in spite of techniques already described [1,2]. Our objective is to show a reproducible technique of bleeding control during mini invasive myomectomy. We performed a mini-invasive myomectomy using with robotic surgery, with Da Vinci, X. We describe the case of a 35 year-old women, gesta 0 para 0, who presented with menorrhagia, avec pelvic pain, because of a fibroma FIGO 2-5 of 8 cm. She had a desire of pregnancy. We show tips and tricks to control bleeding: (a) two ways of accessing to uterine artery for its occlusion, using either a vascular clamp or a metallic clip; (b) sub serous infiltration with 20 mL of xylocaine with 1% adrenalin, diluated in 100 mL of NaCl serum using a oocyte punction needle; (c) suture with barbed suture. Blood loss was <200 mL.