Approach to Uterine Artery Occlusion at Myomectomy

Abstract

Video abstract summary Objective To demonstrate three approaches to uterine artery occlusion at time of myomectomy as a blood-sparing intra-operative technique and review available evidence in the literature. Study methods We proceed with a step-by-step explanation of the procedure with surgical video footage and discuss the available literature on its effectiveness. Results A step-wise approach is applied prior to beginning the myomectomy portion of the procedure which includes the following: 1) selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) based on individual anatomy; 2) identifying relevant anatomy and important landmarks for the procedure 3) isolating the uterine artery and identifying the ureter; 4) occluding the uterine artery. A recent systematic review and meta-analysis supports uterine artery occlusion as a technique to reduce blood loss and blood transfusion, while minimally increasing operative times. Conclusion(s) Uterine artery occlusion can be performed by three different approaches, as have been demonstrated in this video, and is an effective measure at reducing intra-operative blood loss, albeit at the cost of slightly longer operative times.