Skip to main content
Erschienen in: Archives of Gynecology and Obstetrics 5/2012

01.11.2012 | General Gynecology

Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy

verfasst von: Giuseppe Vercellino, Evrim Erdemoglu, Aries Joe, Werner Hopfenmueller, Bernd Holthaus, Christhardt Köhler, Achim Schneider, Kati Hasenbein, Vito Chiantera

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 5/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Our aim is to study the feasibility and effect of bilateral laparoscopic temporary occlusion of uterine arteries by special vascular clamps on blood loss during laparoscopic myomectomy.

Methods

Of 166 women with symptomatic uterine myomas necessitating surgical intervention who wished to retain their uteri, 80 underwent laparoscopic uterine artery clipping and myomectomy (experimental group) and 86 received laparoscopic myomectomy only (control group). Main outcome measures were operating time, number and weight of leiomyomas, blood loss, Doppler examination of the uterine arteries and complications of procedure.

Results

In the experimental group the median hemoglobin drop measured on day 3 postoperatively was 1.2 g/dl. In the control group the mean hemoglobin drop measured on day 3 postoperatively was 1.45 g/dl. The time needed to put the clips in place (the time from the opening of the retroperitoneum and the positioning of the clips) varied between 6 and 40 min. No patient required blood transfusion. There were no conspicuous complications.

Conclusion

The use of the clips has proved to be statistically effective in reducing hemoglobin loss during laparoscopic myomectomy.
Literatur
1.
Zurück zum Zitat Downes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C et al (2010) The burden of fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol 152:96–102PubMedCrossRef Downes E, Sikirica V, Gilabert-Estelles J, Bolge SC, Dodd SL, Maroulis C et al (2010) The burden of fibroids in five European countries. Eur J Obstet Gynecol Reprod Biol 152:96–102PubMedCrossRef
2.
Zurück zum Zitat Paul GP, Naik SA, Madhu KN, Thomas T (2010) Complications of laparoscopic myomectomy: a single surgeon’s series of 1001 cases. Aust N Z J Obstet Gynaecol 50:385–390PubMedCrossRef Paul GP, Naik SA, Madhu KN, Thomas T (2010) Complications of laparoscopic myomectomy: a single surgeon’s series of 1001 cases. Aust N Z J Obstet Gynaecol 50:385–390PubMedCrossRef
3.
Zurück zum Zitat Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG (2007) Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 13:465–476PubMedCrossRef Somigliana E, Vercellini P, Daguati R, Pasin R, De Giorgi O, Crosignani PG (2007) Fibroids and female reproduction: a critical analysis of the evidence. Hum Reprod Update 13:465–476PubMedCrossRef
4.
Zurück zum Zitat Stein K, Ascher-Walsh C (2009) A comprehensive approach to the treatment of uterine leiomyomata. Mt Sinai J Med 76:546–556PubMedCrossRef Stein K, Ascher-Walsh C (2009) A comprehensive approach to the treatment of uterine leiomyomata. Mt Sinai J Med 76:546–556PubMedCrossRef
5.
Zurück zum Zitat Somigliana E, Vercellini P, Benaglia L, Abbiati A, Barbara G, Fedele L (2008) The role of myomectomy in fertility enhancement. Curr Opin Obstet Gynecol 20(4):379–385PubMedCrossRef Somigliana E, Vercellini P, Benaglia L, Abbiati A, Barbara G, Fedele L (2008) The role of myomectomy in fertility enhancement. Curr Opin Obstet Gynecol 20(4):379–385PubMedCrossRef
6.
Zurück zum Zitat Hackethal A, Brüggmann D, Leis A, Langde S, Stillger R, Münstedt K (2009) Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004. Fertil Steril 91:862–868PubMedCrossRef Hackethal A, Brüggmann D, Leis A, Langde S, Stillger R, Münstedt K (2009) Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004. Fertil Steril 91:862–868PubMedCrossRef
7.
Zurück zum Zitat Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L et al (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 14:453–462PubMedCrossRef Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L et al (2007) Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 14:453–462PubMedCrossRef
8.
Zurück zum Zitat Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K et al (2009) Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 145(1):14–21PubMedCrossRef Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K et al (2009) Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 145(1):14–21PubMedCrossRef
10.
Zurück zum Zitat Fletcher H, Frederick J, Hardie M, Simeon D (1996) A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 87:1014–1018PubMedCrossRef Fletcher H, Frederick J, Hardie M, Simeon D (1996) A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 87:1014–1018PubMedCrossRef
11.
Zurück zum Zitat Walid MS, Heaton RL (2010) Laparoscopic myomectomy: an intent-to-treat study. Arch Gynecol Obstet 281:645–649PubMedCrossRef Walid MS, Heaton RL (2010) Laparoscopic myomectomy: an intent-to-treat study. Arch Gynecol Obstet 281:645–649PubMedCrossRef
12.
Zurück zum Zitat Koehler C, Hasenbein K, Klemm P, Tozzi R, Schneider A (2003) Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels. Surg Endosc 17:485–490CrossRef Koehler C, Hasenbein K, Klemm P, Tozzi R, Schneider A (2003) Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels. Surg Endosc 17:485–490CrossRef
13.
Zurück zum Zitat Köhler C, Hasenbein K, Klemm P, Tozzi R, Michels W, Schneider A (2004) Laparoscopic coagulation of the uterine blood supply in laparoscopic-assisted vaginal hysterectomy is associated with less blood loss. Eur J Gynaecol Oncol 25:453–456PubMed Köhler C, Hasenbein K, Klemm P, Tozzi R, Michels W, Schneider A (2004) Laparoscopic coagulation of the uterine blood supply in laparoscopic-assisted vaginal hysterectomy is associated with less blood loss. Eur J Gynaecol Oncol 25:453–456PubMed
14.
Zurück zum Zitat Bonney V (1931) The technique and results of myomectomy. Lancet 220:171–177CrossRef Bonney V (1931) The technique and results of myomectomy. Lancet 220:171–177CrossRef
15.
Zurück zum Zitat Lock FR (1969) Multiple myomectomy. Am J Obstet Gynecol 104:642–650PubMed Lock FR (1969) Multiple myomectomy. Am J Obstet Gynecol 104:642–650PubMed
16.
Zurück zum Zitat Liu WM (2000) Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc 7:125–129PubMedCrossRef Liu WM (2000) Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc 7:125–129PubMedCrossRef
17.
Zurück zum Zitat Alborzi S, Ghannadan E, Alborzi S, Alborzi M (2009) A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma. Fertil Steril 92:742–747PubMedCrossRef Alborzi S, Ghannadan E, Alborzi S, Alborzi M (2009) A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma. Fertil Steril 92:742–747PubMedCrossRef
18.
Zurück zum Zitat Goldberg J, Pereira L (2006) Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol 18:402–406PubMedCrossRef Goldberg J, Pereira L (2006) Pregnancy outcomes following treatment for fibroids: uterine fibroid embolization versus laparoscopic myomectomy. Curr Opin Obstet Gynecol 18:402–406PubMedCrossRef
19.
Zurück zum Zitat Goldberg J, Pereira L, Berghella V, Diamond J, Daraï E, Seinera P et al (2004) Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol 191:18–21PubMedCrossRef Goldberg J, Pereira L, Berghella V, Diamond J, Daraï E, Seinera P et al (2004) Pregnancy outcomes after treatment for fibromyomata: uterine artery embolization versus laparoscopic myomectomy. Am J Obstet Gynecol 191:18–21PubMedCrossRef
20.
Zurück zum Zitat Goldberg J, Berghella V, Pereira L (2002) Pregnancy after uterine artery embolization. Obstet Gynecol 100:869–872PubMedCrossRef Goldberg J, Berghella V, Pereira L (2002) Pregnancy after uterine artery embolization. Obstet Gynecol 100:869–872PubMedCrossRef
21.
Zurück zum Zitat Voss M, Koehler C, Elger F, Kruppa S, Schneider A (2007) Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases. Gynecol Surg 4:101–105CrossRef Voss M, Koehler C, Elger F, Kruppa S, Schneider A (2007) Temporary clipping of the uterine artery during laparoscopic myomectomy—a new technique and the results of first cases. Gynecol Surg 4:101–105CrossRef
22.
Zurück zum Zitat Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M (1994) Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol 101:435–437PubMedCrossRef Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M (1994) Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol 101:435–437PubMedCrossRef
23.
Zurück zum Zitat Zullo F, Palomba S, Corea D, Pellicano M, Russo T, Falbo A et al (2004) Bupivacaine plus epinephrine for laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol 104:242–249CrossRef Zullo F, Palomba S, Corea D, Pellicano M, Russo T, Falbo A et al (2004) Bupivacaine plus epinephrine for laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol 104:242–249CrossRef
24.
Zurück zum Zitat Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A (2005) Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial. Br J Obstet Gynaecol 112:340–345CrossRef Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A (2005) Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial. Br J Obstet Gynaecol 112:340–345CrossRef
25.
Zurück zum Zitat Celik H, Sapmaz E (2003) Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 79:1207–1210PubMedCrossRef Celik H, Sapmaz E (2003) Use of a single preoperative dose of misoprostol is efficacious for patients who undergo abdominal myomectomy. Fertil Steril 79:1207–1210PubMedCrossRef
26.
Zurück zum Zitat Benassi L, Lopopolo G, Pazzoni F, Ricci L, Kaihura C, Piazza F et al (2000) Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy. J Am Coll Surg 191:65–69PubMedCrossRef Benassi L, Lopopolo G, Pazzoni F, Ricci L, Kaihura C, Piazza F et al (2000) Chemically assisted dissection of tissues: an interesting support in abdominal myomectomy. J Am Coll Surg 191:65–69PubMedCrossRef
27.
Zurück zum Zitat Tulandi T, Beique F, Kimia M (1996) Pulmonary edema: a complication of local injection of vasopressin at laparoscopy. Fertil Steril 66:478–480PubMed Tulandi T, Beique F, Kimia M (1996) Pulmonary edema: a complication of local injection of vasopressin at laparoscopy. Fertil Steril 66:478–480PubMed
Metadaten
Titel
Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy
verfasst von
Giuseppe Vercellino
Evrim Erdemoglu
Aries Joe
Werner Hopfenmueller
Bernd Holthaus
Christhardt Köhler
Achim Schneider
Kati Hasenbein
Vito Chiantera
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 5/2012
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-012-2419-y

Weitere Artikel der Ausgabe 5/2012

Archives of Gynecology and Obstetrics 5/2012 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.