Laparoscopic myomectomy (LM) with bilateral temporary occlusion of the internal iliac arteries (IIA)

LM is a difficult procedure due to abundant blood supply to the uterus. Increased bleeding violates the visualization and affects the quality of the superposition seam, increases the blood loss and forces the surgeon to use the excessive coagulation, and sometimes resort to conversion. Described problems could be solved by temporary clamping of blood vessels that feed the uterus.

A retrospective analysis of 74 cases LCM at Kaliningrad's emergency hospital since 2009 was made. Age of the patients –27 to 51 years. Numbers of removed myoma nodes in a single operation were from one to nine.

Patients divided into two groups. Group I: 57 patients who underwent simple laparoscopic myomectomy (SLM). Group II: 17 patients where the operation also included bilateral isolation and temporary clamping of IIA (laparoscopic myomectomy with occlusion (LMO)).

There were no differences among the patients in both groups for age, number and location of myoma nodes (p>0.05). The maximum size of the removed nodes in average was almost twice as much in the second group –60.3mm vs. 36.4mm. The operation time in the first group was significantly less, 130.9±56 minutes, compared with the second one –187.9±26.3min. However, the intraoperative blood loss in the SLM group was significantly higher –346.1±151ml, compared with group II –154.4±54ml.

There were no any complications associated with myomectomy as well as with vascular part of procedure for the LMO, while in the first group 7 cases were converted to open access, mostly due to excessive blood loss. In addition, the postoperative fever was often observed in group I, which, however, did not affect the duration of postoperative hospital stay.

A subgroup of patients with myoma nodes less than 30mm who underwent LMS was separately investigated. The volume of their intraoperative blood loss was similar to those in the second group with an average of 200ml, but the duration of the surgery was significantly less.

Conclusions:

1. Laparoscopic myomectomy with a temporary clamping of the internal iliac artery is a safe procedure, allowing reducing blood loss and improving the quality of the suturing with large myoma nodes.

The myomas up to 30mm could be removed by SLM without vascular clamping with small intraoperative blood loss and a better timing.