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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

Cervical and fundal myoma
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Figure 16: Cervical and fundal myoma

Mentions: In cases of lower segment myomas or cervical myomas we ligate the uterine vessels at their origin from the anterior division of the internal iliac [Figure 16][8]. We start the dissection for vessel ligation from the anterior leaf of the broad ligament. The triangle enclosed by the round ligament, external iliac artery, and infundibulopelvic ligament is opened with the harmonic ultracision [Figure 17]. The areolar space is dissected and the origin of the uterine artery from the internal iliac is identified. It is important at this point to also identify the ureter and its relation to the uterine artery in order to avoid inadvertent ligation. The uterine artery is isolated from the surrounding structures and sutured with a No. 1-0 delayed absorbable suture [Figure 18]. Suturing can be done with a free tie or a needle. The myoma turns pale after bilateral suturing of the uterine arteries. The myoma is enucleated from its bed by traction and counter traction [Figures 19 and 20]. The myoma capsule is closed with interrupted intracorporeal sutures [Figures 21 and 22]. The myoma is retrieved by morcellation [23].


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)

Cervical and fundal myoma
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 16: Cervical and fundal myoma
Mentions: In cases of lower segment myomas or cervical myomas we ligate the uterine vessels at their origin from the anterior division of the internal iliac [Figure 16][8]. We start the dissection for vessel ligation from the anterior leaf of the broad ligament. The triangle enclosed by the round ligament, external iliac artery, and infundibulopelvic ligament is opened with the harmonic ultracision [Figure 17]. The areolar space is dissected and the origin of the uterine artery from the internal iliac is identified. It is important at this point to also identify the ureter and its relation to the uterine artery in order to avoid inadvertent ligation. The uterine artery is isolated from the surrounding structures and sutured with a No. 1-0 delayed absorbable suture [Figure 18]. Suturing can be done with a free tie or a needle. The myoma turns pale after bilateral suturing of the uterine arteries. The myoma is enucleated from its bed by traction and counter traction [Figures 19 and 20]. The myoma capsule is closed with interrupted intracorporeal sutures [Figures 21 and 22]. The myoma is retrieved by morcellation [23].

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