Laparoscopic Uterine Artery Ligation for Myomectomy

Abstract

Objective: To assess the usefulness of laparoscopic uterine artery ligation (LUAL) for laparoscopic myomectomy.
Materials and Methods: Twenty-six patients with intramural and subserosal myomas underwent the LUAL procedure in cases of laparoscopic myomectomy. After the identification of the course of uterine arteries, and the size and location of uterine myomas by using ultrasonography, MRI, CT, and/or 3D-CT, the unilateral or bilateral uterine arteries were ligated laparoscopically before the myomectomy. The decision whether the unilateral or bilateral uterine arteries were ligated was made based on the following factors: the main feeding artery of the dominant nodule being evident or not, the number and location of nodules, patient's age as well as the patient's wish to preserve fertility, and so on.
Results: The unilateral and/or bilateral LUAL procedures were successfully performed on all patients. One conversion to a laparotomy occurred because of a technical difficulty in enucleating a large cervical nodule. The remaining 25 patients were completed a laparoscopic myomectomy after the LUAL procedure. The estimated blood loss was less than 30ml in 22 patients, and the others were 150ml, 200ml, and 300ml in the completed cases, respectively. Two women conceived spontaneously. One woman delivered a baby, and the other experienced a miscarriage. No intraoperative and postoperative complications were observed.
Conclusion: The LUAL procedure, especially the unilateral procedure, prior to myomectomy is an effective and feasible way to reduce operative blood loss and thermal tissue damage by hemostasis procedure.