Abstract
Purpose
Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues.
Methods
We conducted a literature review to define the role of preventive uterine artery occlusion during laparoscopic myomectomy.
Results
Nine non-randomized case–control studies and two randomized controlled trials were identified. The permanent and bilateral uterine artery occlusion technique is the most studied in the literature. The main purpose of facilitating the operative procedure by reducing blood loss has not been clearly demonstrated in randomized trials. Observational comparative studies found an improvement in the effectiveness of treatment, both on clinical symptoms and on the recurrence of leiomyomas. Finally, there are few data examining the effect of uterine artery occlusion on later fertility in female patients of childbearing age, which limits its current use.
Conclusion
The preventive occlusion of uterine arteries is a safe surgical technique that can be performed during laparoscopic myomectomy. Further randomized studies are needed to better define the role of uterine artery occlusion in the surgical strategy, especially for women who want to preserve their fertility.
Similar content being viewed by others
References
Duhan N (2013) Advances in management of uterine myomas. Front Biosci (Elite Ed) 5:12–22
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, Derrien J, Giraudet G, Kahn V, Koskas M, Legendre G, Lucot JP, Niro J, Panel P, Pelage JP, Fernandez H (2012) CNGOF (French College of Gynecology and Obstetrics). Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol 165(2):156–164
Falcone T, Bedaiwy MA (2002) Minimally invasive management of uterine fibroids. Curr Opin Obstet Gynecol. 14(4):401–407 (Review)
Dubuisson JB (2000) Management of leiomyomata. Hum Reprod Update 6(6):587
LaMorte AI, Lalwani S, Diamond MP (1993) Morbidity associated with abdominal myomectomy. Obstet Gynecol 82(6):897–900
Kongnyuy EJ, Wiysonge CS (2011) Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 11:CD005355
Nezhat FR et al (1998) Recurrence rate after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 5(3):237–240
Buttram VC, Reiter RC (1981) Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 36(4):433–445
Malone LJ (1969) Myomectomy: recurrence after removal of solitary and multiple myomas. Obstet Gynecol 34(2):200–203
Acien P, Quereda F (1996) Abdominal myomectomy: results of a simple operative technique. Fertil Steril 65(1):41–51
Dubuisson JB (2007) How I perform…the preventive occlusion of the uterine arteries before myomectomy or hysterectomy? Gynecol Obstet Fertil 35(12):1264–1267
Liu WM et al (2004) Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroids. Fertil Steril 82(1):205–210
Dubuisson JB, Jacob S, Chapron C, Rambaud D (2004) Preventive artery occlusion combined with laparoscopic myomectomy: a valid procedure to prevent bleeding. J Gynecol Surg 20:105–112
Holub Z, Jabor A, Lukac J, Kliment L, Urbanek S (2005) Laparoscopic myomectomy with lateral dissection of the uterine artery. JSLS 9(4):447–453
Liu WM et al (2007) Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas. Fertil Steril 87(2):356–361
Alborzi S et al (2009) A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma. Fertil Steril 92(2):742–747
Liu L, Li Y, Xu H, Chen Y, Zhang G, Liang Z (2011) Laparoscopic transient uterine artery occlusion and myomectomy for symptomatic uterine myoma. Fertil Steril 95(1):254–258
Bae JH, Chong GO, Seong WJ, Hong DG, Lee YS (2011) Benefit of uterine artery ligation in laparoscopic myomectomy. Fertil Steril 95(2):775–778
Kwon YS, Jung DY, Lee SH, Ahn JW, Roh HJ, Im KS (2013) Transient occlusion of uterine arteries with endoscopic vascular clip preceding laparoscopic myomectomy. J Laparoendosc Adv Surg Tech A 23(8):679–683
Holub Z, Jabor A, Lukac J, Kliment L, Urbanek S, Shibalova E (2004) The effect of lateral uterine artery dissection on clinical outcomes in laparoscopic myomectomy: a prospective randomized study. Gynecol Surg 1:253–258
Vercellino G et al (2012) Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy. Arch Gynecol Obstet 286(5):1181–1186
Holub Z, Eim J, Jabor A, Hendl A, Lukac J, Kliment L (2006) Complications and myoma recurrence after laparoscopic uterine artery occlusion for symptomatic myomas. J Obstet Gynaecol Res 32(1):55–62
Liu WM (2000) Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc 7(1):125–129
Wang PH et al (2008) Laparoscopic uterine vessel occlusion in the treatment of women with symptomatic uterine myomas with and without adding laparoscopic myomectomy: 4-year results. J Minim Invasive Gynecol 15(6):712–718
Farrer-Brown G, Beilby JO, Tarbit MH (1970) The blood supply of the uterus. 1. Arterial vasculature. J Obstet Gynaecol Br Commonw 77(8):673–681
Lichtinger M et al (2003) The time course of myometrial ischemia and reperfusion after laparoscopic uterine artery occlusion—theoretical implications. J Am Assoc Gynecol Laparosc 10(4):554–563 (quiz 564–566)
Razavi MK et al (2002) Angiographic classification of ovarian artery-to-uterine artery anastomoses: initial observations in uterine fibroid embolization. Radiology 224(3):707–712
Gupta JK, Sinha A, Lumsden MA, Hickey M (2012) Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev 16(5):CD005073
Wang HY, Quan S, Zhang RL, Ye HY, Bi YL, Jiang ZM, Ng EH (2013) Comparison of serum anti-Mullerian hormone levels following hysterectomy and myomectomy for benign gynaecological conditions. Eur J Obstet Gynecol Reprod Biol 171(2):368–371
Cela V et al (2013) Fertility and endocrine outcome after robot-assisted laparoscopic myomectomy (RALM). Gynecol Endocrinol 29(1):79–82
Qu X et al (2010) Controlled clinical trial assessing the effect of laparoscopic uterine arterial occlusion on ovarian reserve. J Minim Invasive Gynecol 17(1):47–52
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dubuisson, J., Ramyead, L. & Streuli, I. The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature. Arch Gynecol Obstet 291, 737–743 (2015). https://doi.org/10.1007/s00404-014-3546-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-014-3546-4