Laparoscopic Uterine Artery Occlusion for Symptomatic Leiomyomas

Abstract

Study ObjectiveTo describe a laparoscopic technique that safely occludes both uterine arteries, overcoming an altered surgical field resulting from scarring and/or uterine leiomyomatous growth. DesignProspective analysis (Canadian Task Force classification II-2). SettingNonprofit community hospital. PatientsEight women with leiomyomas with abnormal uterine bleeding, pelvic pain or pressure, and/or anemia. InterventionBilateral laparoscopic retroperitoneal uterine artery occlusion. Measurements and Main ResultsOcclusion at the initial track of the uterine artery was performed by laparoscopic coated ligature in six patients. In two obese patients with deep retroperitoneal space, vascular clips were placed endoscopically using the same dissecting technique. All patients were discharged within 20 hours after the procedure. All five women with abnormal bleeding reported satisfactory decrease; none reported amenorrhea. Of eight with preoperative pain or pressure, seven reported complete disappearance and one significant relief. All three patients with anemia had normal red cell counts after 1 month. ConclusionLaparoscopic uterine artery occlusion using a lateral retroperitoneal technique is safe and effective in women with pelvic scarring and altered pelvic anatomy.