In abdominal myomectomy: the role of legating uterine arteries bilaterally before performing myomectomy (bual- bilateral uterine artery ligation).
Abstract
Aims and Objectives: To determine the impact, efficacy, benefits of such low cost safe technological option (BUAL) in areas where high level surgical interventions are restricted.
Methods and Materials: The total sixty six (66)cases have been selected on random basis of which thirty three (33)cases allocated in group A (n=33) (cases) were operated by this method (BUAL)and others in group B (n=33)(controls) were operated by other methods (Bonney’s clamp ,tourniquet or vasopressin).
Results and Analysis: The results of individual group have been analyzed in the form of primary outcome and secondary outcome. There are statistically significant less blood loss, less transfusion, less operation time with good post-operative recovery and satisfaction by low cost in Gr-A(Cases) compare to Gr-B (Controls).
Conclusion: The bilateral uterine artery ligation should be ligated before starting myomectomy not only open but also laparoscopic method to minimize complications.
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References
Okolo S. Incidence, aetiology and epidemiology of uterine fibroids. Best Practice & Research Clin Obstet & Gynaecol. 2008;22(4):571-588. doi: 10.1016/j.bpobgyn.2008.04.002. Epub 2008 Jun 4.
Downes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C, et al. The burden of uterine fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol. 2010;152(1):96-102. doi: 10.1016/j.ejogrb.2010.05.012. Epub 2010 Jul 3.
Pritts EA, Parker WH, Olive DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91(4):1215-1223. doi: 10.1016/j.fertnstert.2008.01.051. Epub 2008 Mar 12.
Kitson S, Macphail S, Bulmer J, et al. Is pregnancy safe after uterine artery embolisation. BJOG. 2012; 119:519–21. [PubMed] [Google Scholar].
Bedient CE, Magrina JF, Noble BN, Kho RM. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol. 2009;201(6):566e1-566e5. doi: 10.1016/j.ajog.2009.05.049. Epub 2009 Aug 15.
Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases. Australian and New Zealand Journal of Obstet and Gynecol. 2010; 50(4):385-390. doi: 10.1111/j.1479-828X.2010.01191.x.
Lik WM, Tzeng CR, Yi-JenC, Wang PH. Combining the uterine depletion procedure and myomectomy may be helpful for treating symptomatic fibroid. Fertil Steril.2004;82(1):205-210. doi: https://doi.org/10.1016/j.fertnstert.2004.01.026.
Base JH, Chong GO, Seong WJ, Hong DG, Lee YS.Benefit of uterine artery ligation in laparoscopic myomectomy.Fertil Steril. 2011;95(2):775-778. doi: 10.1016/j.fertnstert.2010.07.1079.
Akinda OI, Fabamwo AO, Akinda RA, Ottum TA, Akinniyi A, Akpan AE. Uterine artery ligatiomn for treatment of fibroid. Acts Obstet Gynecol Scand.2009;88(1):59-62. doi: 10.1080/00016340802632366.
Sinha R, Hegde A,Warty N, Mahajan C. Laparoscopic myomectomy: Enucleation of myoma by morcellation which attached to uterus. J Minimum Invasive Gynecol.2005;12(3):284-289. doi: https://doi.org/10.1016/j.jmig.2005.03.018.
Sapmaz E, Celik H, Altungil A. Bilateral uterine artery ligation VS tourniquets use for haemostasis in caesarean myomectomy. The J Reproduct Med. 2003,48(12):950-954.
O’Leary JL, O’ Leary JA. Uterine artery ligation in control of intractable PPH. Am J Obstct Gynae 1966;94(7):920-924.
Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007;356:360-370. doi: 10.1056/NEJMoa062003.
Cheng Z, Yang W, Dai H, Hu L, Qu X, Kang L. Laparoscopic uterine artery occlusion combined with myomectomy for uterine myomas. J Minim Invasive Gynecol. 2008;15(3):346-349. doi: 10.1016/j.jmig.2008.01.005. Epub 2008 Mar 20.
Wang PH, Liu WM, Fuh JL, Chao HT, Chao KC, Yuan CC. Laparoscopic uterine vessel occlusion in the treatment of women with symptomatic uterine myomas with and without adding laparoscopic myomectomy: 4-Year Results. J Minima Invasive Gynecol. 2008; 15(6):712-718. doi: 10.1016/j.jmig.2008.08.005.
Lipshutz B. A composite study of the hypogastric artery and its branches. Ann Surg. 1918;67(5):584-608. doi: 10.1097/00000658-191805000-00012.
Borell U, Fernstrom I. The adnexal branches of the uterine artery. An arteriographic study in human subjects. Acta Radiol. 1953;40(6):561-582.
Burchell RC. Arterial physiology of the human female pelvis. Obstet Gynecol. 1968;31(6):855-860.
Lichtinger M, Burbank F, Hallson L, Herbert S, Uyeno J, Jones M. The time course of myometrial ischemia and reperfusion after laparoscopic uterine artery occlusion-Theoretical implications. J Am Assoc Gynecol Laparosc. 2003;10(4):553-563. doi: 10.1016/S1074-3804(05)60168-5.
Burbank F, Hutchins FL., Jr Uterine artery occlusion by embolization or surgery for the treatment of fibroids: A unifying hypothesis–transient uterine ischemia. J Am Assoc Gynecol Laparosc. 2000;7(4):S1-S49. doi: 10.1016/S1074-3804(05)60633-0.
Liu WM, Tzeng CR, Yi-Jen C, Wang PH. Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids. Fertil Steril. 2004;82(1):205-210.doi: https://doi.org/10.1016/j.fertnstert.2004.01.026
Sinha R, Hegde A, Warty N, Patil N. Laparoscopic. Excision of Very Large Myomas. J Am Assoc Gynecol Laparosc. 2003;10(4):461-468.
Shinagawa S. Extraperitoneal ligation of the internal iliac arteries as a life- and uterus-saving procedure for uncontrolled postpartum hemorrhage. Am J Obstet Gynecol. 1964; 88:130-131.
Lenzi G. Pregnancy after ligation of uterine arteries. Attual Ostet Ginecol. 1969;15(1):31-35.
Liberman G. Normal labor after ligation of major vessels of the uterus. Akush Ginekol. 1966; 42(12):45-46.
Holub Z, Lukac J, Kliment L, Urbanek S. Pregnancy outcomes and deliveries following laparoscopic transsection of uterine vessels: A pilot study. Eur J Obstet Gynecol Reprod Biol. 2006;125(2):165-170. doi: https://doi.org/10.1016/j.ejogrb.2005.06.021.
Tulandi T, Sammour A, Valenti D, Child TJ, Seti L, Tan SL. Ovarian reserve after uterine artery embolization for leiomyomata. Fertil Steril. 2002;78(1):197-198. doi: https://doi.org/10.1016/S0015-0282(02)03164-3.
Ryu RK, Chrisman HB, Omary RA, Miljkovic S, Nemcek AA, Jr, Saker MB, et al. The vascular impact of uterine artery embolization: Prospective sonographic assessment of ovarian arterial circulation. J Vasc Interv Radiol. 2001;12(9):1071-1074. doi: 10.1016/s1051-0443(07)61594-2.
Liu WM. Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc. 2000;7(1):129-131.
Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007;356:360-370. doi: 10.1056/NEJMoa062003.
Cheng Z, Yang W, Dai H, Hu L, Qu X, Kang L. Laparoscopic uterine artery occlusion combined with myomectomy for uterine myomas. J Minim Invasive Gynecol. 2008;15(3):346-349. doi: https://doi.org/10.1016/j.jmig.2008.01.005
Wang PH, Liu WM, Fuh JL, Chao HT, Chao KC, Yuan CC. Laparoscopic uterine vessel occlusion in the treatment of women with symptomatic uterine myomas with and without adding laparoscopic myomectomy: 4-Year Results. J Minima Invasive Gynecol. 2008;15(6):712-718. doi: 10.1016/j.jmig.2008.08.005.
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