Cable ties as tourniquets at open myomectomy

Abstract

The major risk of open myomectomy is intraoperative hemorrhage, and several strategies have been suggested to reduce bleeding [1]. While injections of dilute vasopressin or its derivatives are the most widely used, tourniquets that render the uterus avascular during surgery are the most effective. The classic technique involves placing a clamp, catheter, or suture around the cervix (single tourniquet technique) and the infundibulopelvic ligaments (triple tourniquet technique) to occlude the uterine and ovarian blood supplies respectively. As an alternative technique for vascular occlusion, we used sterilized cable ties at open myomectomy performed in 14 patients. The average age of the patients was 39.6 years (range, 28–46 years), and uterine sizes ranged from 14–26 weeks of gestation with a median of 17 weeks. Five patients were pre-treated with GnRH analogues (as part of a randomized study), and one had undergone an unsuccessful uterine artery embolization. All but two of the procedures were performed through transverse laparotomy incisions. We used commercially available 25-cm cable ties purchased from a hardware store (Fig. 1). The cable ties were sterilized individually by steam autoclave and packaged in the hospital's Central Sterilization Unit. The use of cable ties was agreed by the hospital authorities, and as it was considered a service development, ethical approval was not required.