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Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery

INTRODUCTION: Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric ar...

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Autores principales: Balulescu, Ligia, Nistor, Samuel, Lungeanu, Diana, Brasoveanu, Simona, Pirtea, Marilena, Secosan, Cristina, Grigoras, Dorin, Caprariu, Radu, Pasquini, Andrea, Pirtea, Laurentiu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477596/
https://www.ncbi.nlm.nih.gov/pubmed/37675138
http://dx.doi.org/10.3389/fmed.2023.1216455
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author Balulescu, Ligia
Nistor, Samuel
Lungeanu, Diana
Brasoveanu, Simona
Pirtea, Marilena
Secosan, Cristina
Grigoras, Dorin
Caprariu, Radu
Pasquini, Andrea
Pirtea, Laurentiu
author_facet Balulescu, Ligia
Nistor, Samuel
Lungeanu, Diana
Brasoveanu, Simona
Pirtea, Marilena
Secosan, Cristina
Grigoras, Dorin
Caprariu, Radu
Pasquini, Andrea
Pirtea, Laurentiu
author_sort Balulescu, Ligia
collection PubMed
description INTRODUCTION: Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. MATERIALS AND METHODS: This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: “LM + TOHA” group (29 patients), and “LM” group (31 patients). The study’s main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). RESULTS: Delta Hb was statistically lower in the “LM + TOHA” group compared to “LM” group, with mean ± standard (min–max): 1.68 ± 0.67 (0.39–3.99) vs. 2.63 ± 1.06 (0.83–4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the “LM” group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in “LM + TOHA” group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7–15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. DISCUSSION: Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. CLINICAL TRIAL REGISTRATION: ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.
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spelling pubmed-104775962023-09-06 Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery Balulescu, Ligia Nistor, Samuel Lungeanu, Diana Brasoveanu, Simona Pirtea, Marilena Secosan, Cristina Grigoras, Dorin Caprariu, Radu Pasquini, Andrea Pirtea, Laurentiu Front Med (Lausanne) Medicine INTRODUCTION: Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. MATERIALS AND METHODS: This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: “LM + TOHA” group (29 patients), and “LM” group (31 patients). The study’s main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). RESULTS: Delta Hb was statistically lower in the “LM + TOHA” group compared to “LM” group, with mean ± standard (min–max): 1.68 ± 0.67 (0.39–3.99) vs. 2.63 ± 1.06 (0.83–4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the “LM” group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in “LM + TOHA” group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7–15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. DISCUSSION: Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. CLINICAL TRIAL REGISTRATION: ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343. Frontiers Media S.A. 2023-08-22 /pmc/articles/PMC10477596/ /pubmed/37675138 http://dx.doi.org/10.3389/fmed.2023.1216455 Text en Copyright © 2023 Balulescu, Nistor, Lungeanu, Brasoveanu, Pirtea, Secosan, Grigoras, Caprariu, Pasquini and Pirtea. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Balulescu, Ligia
Nistor, Samuel
Lungeanu, Diana
Brasoveanu, Simona
Pirtea, Marilena
Secosan, Cristina
Grigoras, Dorin
Caprariu, Radu
Pasquini, Andrea
Pirtea, Laurentiu
Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title_full Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title_fullStr Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title_full_unstemmed Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title_short Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
title_sort minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477596/
https://www.ncbi.nlm.nih.gov/pubmed/37675138
http://dx.doi.org/10.3389/fmed.2023.1216455
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