Round Ligament Injection with Vasopressin during Myomectomy

Abstract

<h3>Study Objective</h3> To demonstrate the surgical technique of round ligament injection with vasopressin during laparoscopic and abdominal myomectomy as a novel technique to help minimize blood loss. <h3>Design</h3> N/A. <h3>Setting</h3> Academic Hospital System. <h3>Patients or Participants</h3> Our first case is a 32-year-old G0 with large fundal fibroid measuring 5.3 cm who underwent laparoscopic myomectomy. Our second case is a 33-year-old G0 with a large posterior fibroid measuring approximately 17 cm by 15 cm on preoperative MRI who underwent an abdominal myomectomy. <h3>Interventions</h3> We perform round ligament injection at the beginning of both cases prior to starting myomectomy. We first dilute 20 units of vasopressin in 60 mL of injectable saline. After identifying the round ligament, we inject a total of 20 ml of dilute vasopressin approximately halfway along the round ligaments bilaterally. <h3>Measurements and Main Results</h3> Both patients underwent uncomplicated laparoscopic and abdominal myomectomies, respectively. They were both recovering well at their 2-week follow-up visits. <h3>Conclusion</h3> Numerous medical and surgical techniques have been described to minimize potentially significant blood loss during abdominal, laparoscopic, and robotic-assisted myomectomies. In this video, we demonstrate the novel technique for round ligament injection with vasopressin as another adjunct method to use to further help minimize both loss at the time of either laparoscopic or abdominal myomectomy.