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Laparoscopic myomectomy with uterine artery ligation: review article and comparative analysis.

Sinha R, Sundaram M, Mahajan C, Raje S, Kadam P, Rao G - J Gynecol Endosc Surg (2011)

Bottom Line: Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years.There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally.In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.

View Article: PubMed Central - PubMed

Affiliation: Bombay Endoscopy Academy and Center for Minimally Invasive Surgery, Beams Hospital, Mumbai, India.

ABSTRACT
Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Although many women are asymptomatic, problems such as bleeding, pelvic pain, and infertility may necessitate treatment. Laparoscopic myomectomy is one of the treatment options for myomas. The major concern of myomectomy either by open method or by laparoscopy is the bleeding encountered during the procedure. Most studies have aimed at ways of reducing blood loss during myomectomy. There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally. In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.

No MeSH data available.


Related in: MedlinePlus

Multiple fibroids after devascularisation
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Figure 10: Multiple fibroids after devascularisation

Mentions: We prefer to ligate the ascending branch of the uterine artery anteriorly during most laparoscopic myomectomies. The uterovesical fold of the peritoneum is opened and the bladder is pushed down [Figures 3–5]. This moves the ureters laterally and prevents them being included in the suture. The uterine vessels are identified on either side and ligated. We use No. 1 delayed absorbable sutures for ligating the uterine vessels [Figures 6 and 7]. We always prefer to suture intracorporeally by contralateral suturing, using two needle holders. There can be technical difficulties in approaching the uterine vessels in the case of large myomas. There can be some venous bleeding if the uterine vein is accidentally punctured. In such cases the suturing is completed and the venous bleed stops by itself. Once the uterines are occluded bilaterally, the myoma turns pale [Figures 8–10]. This devascularizes the myoma and decreases the blood loss during the procedure.


Laparoscopic myomectomy with uterine artery ligation: review article and comparative analysis.

Sinha R, Sundaram M, Mahajan C, Raje S, Kadam P, Rao G - J Gynecol Endosc Surg (2011)

Multiple fibroids after devascularisation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3304288&req=5

Figure 10: Multiple fibroids after devascularisation
Mentions: We prefer to ligate the ascending branch of the uterine artery anteriorly during most laparoscopic myomectomies. The uterovesical fold of the peritoneum is opened and the bladder is pushed down [Figures 3–5]. This moves the ureters laterally and prevents them being included in the suture. The uterine vessels are identified on either side and ligated. We use No. 1 delayed absorbable sutures for ligating the uterine vessels [Figures 6 and 7]. We always prefer to suture intracorporeally by contralateral suturing, using two needle holders. There can be technical difficulties in approaching the uterine vessels in the case of large myomas. There can be some venous bleeding if the uterine vein is accidentally punctured. In such cases the suturing is completed and the venous bleed stops by itself. Once the uterines are occluded bilaterally, the myoma turns pale [Figures 8–10]. This devascularizes the myoma and decreases the blood loss during the procedure.

Bottom Line: Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years.There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally.In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.

View Article: PubMed Central - PubMed

Affiliation: Bombay Endoscopy Academy and Center for Minimally Invasive Surgery, Beams Hospital, Mumbai, India.

ABSTRACT
Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Although many women are asymptomatic, problems such as bleeding, pelvic pain, and infertility may necessitate treatment. Laparoscopic myomectomy is one of the treatment options for myomas. The major concern of myomectomy either by open method or by laparoscopy is the bleeding encountered during the procedure. Most studies have aimed at ways of reducing blood loss during myomectomy. There are various ways in which bleeding during laparoscopic myomectomy can be reduced, the most reliable of which is ligation of the uterine vessels bilaterally. In this review we propose to discuss the benefits and possible disadvantages of ligating the uterine arteries bilaterally before performing laparoscopic myomectomy.

No MeSH data available.


Related in: MedlinePlus