Andrew Zakhari1, Ari P Sanders1, Ally Murji2. 1. Department of Obstetrics and Gynecology, Mount Sinai Hospital and Women's College Hospital; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. 2. Department of Obstetrics and Gynecology, Mount Sinai Hospital and Women's College Hospital; and Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada. Electronic address: ally.murji@sinaihealthsystem.ca.
Abstract
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.
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.