BACKGROUND: We assessed the results and impact of lateral uterine artery dissection on clinical outcome following laparoscopic myomectomy. METHODS: We retrospectively analyzed the clinical data for 27 laparoscopic myomectomy cases (Group I) and 54 laparoscopic myomectomy cases combined with lateral uterine artery dissection (Group II) between January 2001 and August 2004 in one center. Only 81 patients who had dominant fibroids between 4 cm and 10 cm in diameter were included in the study. We assessed the clinical outcomes: perioperative blood loss, operating time, hospital stay, complications, hemoglobin decrease, inflammatory response, and tissue markers (C-reactive protein, white blood cells, creatinine kinase) changes. RESULTS: The mean operating time was 70.37 minutes in group I and 78.61 minutes in group II. The mean length of hospital stay was 2.7 days versus 2.2 days, respectively (P>0.05). The difference in intraoperative blood loss was 70.1 mL (147.7 mL vs 77.3 mL, Group I) and 33.9 mL (105 mL vs 71.1 mL, Group II); estimated postoperative blood loss was statistically significant (P<0.001, P<0.05, respectively). Group 2 demonstrated a less intense stress response in C-reactive protein (P<0.001) and white blood cell count (P<0.05). CONCLUSION: The dissection of the uterine artery in laparoscopic myomectomy is a feasible operative procedure with a low rate of complications. The procedure reduced perioperative blood loss and resulted in significant improvement in fibroid-related symptoms.

Department of Obstetrics and Gynecology Endoscopic Training Center Baby Friendly Hospital Kladno Czech Republic

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Wallach EE. Myomectomy. In: Thompson JD, Rock JA. ed. Te Linde's Operative Gynaecology, 7th ed. Philadelphia, PA: Lippincott; 1992;647–662

Seidman D, Nezhat CH, Nezhat F, Nezhat C. Laparoscopic management of uterine myoma. In: Tulandi T. ed. Uterine Fibroids, Embolization and Other Treatments. Cambridge, UK: Cambridge University Press; 2003;41–48

Fedele L, Bianchi S, Baglioni A, Arcaini L, Marchiani M, Bocciolone L. Intranasal buserelin versus surgery in the treatment of uterine leiomyomata: long-term follow-up. Eur J Obstet Gynecol Reprod Biol. 1991;38:53–57 PubMed

Nezhat C, Nezhat F, Silfen L, Schaffer N, Evans D. Laparoscopic myomectomy. Int J Fertil. 1991;36:275–280 PubMed

Agostini A, Ronda I, Franchi F, et al. Oxytocin during myomectomy: a randomised study. Eur J Obstet Gynec Reprod Biol. 2005;118:235–238 PubMed

Sapmaz E, Celik H. Comparison of the effects of the ligation of ascending branches of bilateral arteria uterina with tourniquet method on the intra-operative and post-operative hemorrhage in abdominal myomectomy cases. Eur J Gynec Obstet Reprod Biol. 2003;110:74–77 PubMed

Ostrzenski A. A new laparoscopic myomectomy technique for intramural fibroids penetrating the uterine cavity. Eur J Obstet Gynecol Reprod Biol. 1997;74:189–193 PubMed

Liu WM. Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic leiomyomas. J Am Assoc Gynecol Laparosc. 2000;7:125–129 PubMed

Lichtinger M, Hallson L, Calvo P, Adeboyejo G. Laparoscopic uterine artery occlusion for symptomatic leiomyomas. J Am Assoc Gynecol Laparosc. 2000;9:191–198 PubMed

Hald K, Langebrekke A, Klow NE, Noreng HJ, Berge AB, Istre O. Laparoscopic occlusion of uterine vessels for the treatment of symptomatic fibroids: Initial experience and comparison to uterine artery embolization. Am J Obstet Gynecol 2004;190: 37–43 PubMed

Holub Z, Kliment L. Laparoscopic ultrasonic dissection of uterine vessels in women with benign uterine pathology. Clin Exp Obstet Gynecol. 2002;29:54–56 PubMed

Park KH, Kim JY, Shin JS, et al. Treatment outcomes of uterine artery embolization and laparoscopic uterine artery ligation for uterine myoma. Yonsei Med J 2003;44;694–702 PubMed

Liu WM, Tzeng CHR, Yi-Jen CH, Wang PH. Combining the uterine depletion procedure and myomectomy may be useful for treating symptomatic fibroid. Fertil Steril. 2004;82:205–210 PubMed

Holub Z, Jabor A, Lukac J, Kliment L, Urbanek S, Shibalova E. The effect of lateral uterine artery dissection on clinical outcomes in laparoscopic myomectomy: a prospective randomised study. Gynec Surg Endosc Imag All Tech. 2004;1:253–258

Yen YK, Liu WM, Yuan CH, Ng HT. Laparoscopic bipolar coagulation of uterine vessels to treat symptomatic myomas in women with elevated CA 125. J Am Assoc Gynecol Laparosc. 2001;8:241–246 PubMed

Nezhat CR, Nezhat FR, Luciano AA, et al. Operative gynaecologic laparoscopy; principles and techniques. New York, NY: McGraw-Hill; 1995

Serachioli R, Colombo FM, Bagnoli A, Govoni A, Missiroli S, Venturoli S. Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure? BJOG. 2003;110:236–240 PubMed

Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br J Obstet Gynaecol. 1994;101:435–437 PubMed

Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ. The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study. Fertil Steril. 1993;60:956–962 PubMed

Holub Z, Lukac J, Kliment L, Urbanek S. Short-term results from laparoscopic dissection of uterine vessels in women with symptomatic fibroids. Eur J Obstet Gynecol Reprod Biol 2003; 110:94–98 PubMed

Kohler C, Hasenbein K, Klemm P, Tozzi R, Schneider A. Laparoscopic-assisted vaginal hysterectomy with lateral transsection of the uterine vessels. Surg Endosc. 2003;17:485–490 PubMed

Holub Z, Jabor A, Fischlova, Palasek V. Assessment of tissue damage associated with laparoscopic and conventional hysterectomies. Gynaec Endosc. 1998;7:243–249

Dubuisson JB, Malartic C, Jacob S, Chapron Ch, Rambaud D. Preventive uterine artery occlusion combined with laparoscopic myomectomy: a valid procedure to prevent bleeding. J Gynec Surg. 2004;20:105–112