A transient blocking uterine perfusion procedure to decrease operative blood loss in laparoscopic myomectomy

Background: To evaluate the feasibility and effectiveness of reversible ligating clips to block uterine arteries and reduce operative blood loss during laparoscopic myomectomy (LM). Methods: Twenty consecutive women with symptomatic uterine fibroids desiring to preserve the uteri underwent laparoscopic surgery with ligation of the uterine arteries with ligating clips, followed by myomectomy and removal of the clips. Result: Laparoscopic uterine artery ligation with reversible ligating clips was successfully performed in all patients. The median main fibroid diameter and fibroid weight were 7.3 cm (interquartile range [IQR] 7.0-9.0) and 210 g (IQR 150-295 g), respectively. The median operating time was 120 minutes (IQR 100-148 minutes) and blood loss was 100.0 mL (IQR 56.3-137.5 mL). The median number of fibroids removed was 1 (IQR 1-4.3). The median post-operative hospital stay was 3 days (IQR 2-3 days) and no patient developed complications. Menstrual bleeding problems and bulk-related symptoms were controlled in 90.0% and 100% of women, respectively after 6 months of follow-up. One woman conceived spontaneously 4 months after surgery and delivered a baby girl at 38 weeks gestation via cesarean section. Conclusions: Blocking uterine perfusion before LM is valuable and feasible for the management of women with symptomatic fibroids. The procedure controlled operative blood loss without affecting the uterine blood supply after surgery.