NEW YORK (Reuters Health) – For women with symptomatic uterine fibroids wishing to maintain fertility, laparoscopic myomectomy with transient occlusion of the uterine artery during the procedure may have certain advantages, a Chinese team reports in Fertility & Sterility, currently in press.

Lead author Dr. Lubin Liu, at Third Military Medical University, Chongqing, and colleagues note that laparoscopic myomectomy is a challenging operation with high risk of blood loss. They developed a new approach to minimize this problem: laparoscopic transient uterine artery ligation (LTUAL).

The procedure involves temporarily ligating the uterine artery by a slipknot with a surgical suture, performing laparoscopic myomectomy, and then releasing the slipknot.

The team compared laparoscopic myomectomy with or without LTUAL in 167 women. None of the procedures needed converting to laparotomy. Blood loss averaged 75 mL in the occlusion group compared with 170 mL in the standard laparoscopic myomectomy group (p=0.001).

“With the critical problem being tackled, we were able to conduct laparoscopic myomectomy for large, multiple, intrauterine wall and especially submucosal myomas,” Dr. Liu and colleagues point out.

Subsequently, menstrual blood loss was comparable to preoperative levels in both groups, and the transient uterine artery ligation did not affect fertility. Among women who were trying to become pregnant, pregnancy rates were 31.25% in the LTUAL group and 38.10% in the standard group — not a statistically significant difference.

The team also points out that less adhesion formation with laparoscopy as compared to laparotomy could also help reduce the risk of infertility. Overall, they believe that laparoscopic myomectomy with transient uterine artery ligation “is preferable in patients who wish to undergo future pregnancies.”

Reference:

http://dx.doi.org/10.1016/j.fertnstert.2010.05.006

Fertil Steril 2010.