Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery
IntroductionUterine 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 arte...
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Frontiers Media S.A.
2023-08-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1216455/full |
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| author | Ligia Balulescu Ligia Balulescu Samuel Nistor Samuel Nistor Diana Lungeanu Diana Lungeanu Simona Brasoveanu Simona Brasoveanu Marilena Pirtea Marilena Pirtea Cristina Secosan Cristina Secosan Dorin Grigoras Dorin Grigoras Radu Caprariu Andrea Pasquini Andrea Pasquini Laurentiu Pirtea Laurentiu Pirtea |
| author_facet | Ligia Balulescu Ligia Balulescu Samuel Nistor Samuel Nistor Diana Lungeanu Diana Lungeanu Simona Brasoveanu Simona Brasoveanu Marilena Pirtea Marilena Pirtea Cristina Secosan Cristina Secosan Dorin Grigoras Dorin Grigoras Radu Caprariu Andrea Pasquini Andrea Pasquini Laurentiu Pirtea Laurentiu Pirtea |
| author_sort | Ligia Balulescu |
| collection | DOAJ |
| description | IntroductionUterine 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 methodsThis 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).ResultsDelta 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.DiscussionPerforming 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 registrationISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343. |
| first_indexed | 2024-03-12T13:58:45Z |
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| language | English |
| last_indexed | 2024-03-12T13:58:45Z |
| publishDate | 2023-08-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-60b39b8c432c40f58f7afd8cfde4c2cb2023-08-22T09:54:04ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-08-011010.3389/fmed.2023.12164551216455Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric arteryLigia Balulescu0Ligia Balulescu1Samuel Nistor2Samuel Nistor3Diana Lungeanu4Diana Lungeanu5Simona Brasoveanu6Simona Brasoveanu7Marilena Pirtea8Marilena Pirtea9Cristina Secosan10Cristina Secosan11Dorin Grigoras12Dorin Grigoras13Radu Caprariu14Andrea Pasquini15Andrea Pasquini16Laurentiu Pirtea17Laurentiu Pirtea18Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaCenter for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaInstitute of Cardiovascular Diseases, Timisoara, RomaniaCenter for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaDepartment of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaCenter for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania“Pius Brinzeu” County Clinical Emergency Hospital, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, RomaniaDepartment of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, RomaniaIntroductionUterine 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 methodsThis 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).ResultsDelta 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.DiscussionPerforming 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 registrationISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.https://www.frontiersin.org/articles/10.3389/fmed.2023.1216455/fullblood losstemporary occlusion of the hypogastric artery (TOHA)clippingoperative timelaparoscopic myomectomyuterine leiomyoma |
| spellingShingle | Ligia Balulescu Ligia Balulescu Samuel Nistor Samuel Nistor Diana Lungeanu Diana Lungeanu Simona Brasoveanu Simona Brasoveanu Marilena Pirtea Marilena Pirtea Cristina Secosan Cristina Secosan Dorin Grigoras Dorin Grigoras Radu Caprariu Andrea Pasquini Andrea Pasquini Laurentiu Pirtea Laurentiu Pirtea Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery Frontiers in Medicine blood loss temporary occlusion of the hypogastric artery (TOHA) clipping operative time laparoscopic myomectomy uterine leiomyoma |
| 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 | blood loss temporary occlusion of the hypogastric artery (TOHA) clipping operative time laparoscopic myomectomy uterine leiomyoma |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1216455/full |
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