J Dubuisson1, L Ramyead, I Streuli. 1. Department of Gynecology and Obstetrics, University Hospitals of Geneva, 30, Boulevard de la Cluse, 1211, Geneva, Switzerland, jean.dubuisson@hcuge.ch.
Abstract
PURPOSE: Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues. METHODS: We conducted a literature review to define the role of preventive uterine artery occlusion during laparoscopic myomectomy. RESULTS: Nine non-randomized case-control studies and two randomized controlled trials were identified. The permanent and bilateral uterine artery occlusion technique is the most studied in the literature. The main purpose of facilitating the operative procedure by reducing blood loss has not been clearly demonstrated in randomized trials. Observational comparative studies found an improvement in the effectiveness of treatment, both on clinical symptoms and on the recurrence of leiomyomas. Finally, there are few data examining the effect of uterine artery occlusion on later fertility in female patients of childbearing age, which limits its current use. CONCLUSION: The preventive occlusion of uterine arteries is a safe surgical technique that can be performed during laparoscopic myomectomy. Further randomized studies are needed to better define the role of uterine artery occlusion in the surgical strategy, especially for women who want to preserve their fertility.
PURPOSE: Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues. METHODS: We conducted a literature review to define the role of preventive uterine artery occlusion during laparoscopic myomectomy. RESULTS: Nine non-randomized case-control studies and two randomized controlled trials were identified. The permanent and bilateral uterine artery occlusion technique is the most studied in the literature. The main purpose of facilitating the operative procedure by reducing blood loss has not been clearly demonstrated in randomized trials. Observational comparative studies found an improvement in the effectiveness of treatment, both on clinical symptoms and on the recurrence of leiomyomas. Finally, there are few data examining the effect of uterine artery occlusion on later fertility in female patients of childbearing age, which limits its current use. CONCLUSION: The preventive occlusion of uterine arteries is a safe surgical technique that can be performed during laparoscopic myomectomy. Further randomized studies are needed to better define the role of uterine artery occlusion in the surgical strategy, especially for women who want to preserve their fertility.