Temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy for cervical myoma

Abstract

Objective To report our initial experience with temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy (LAVH) for cervical myoma. Study design Thirteen patients with cervical myoma were treated by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries from September 2008 to October 2010. Preoperative evaluation of cervical myoma was made by ultrasonography, magnetic resonance imaging and three-dimensional computerized tomographic angiography, and curative management was made by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. Results Nine patients with extracervical myoma and 4 patients with intracervical myoma were successfully managed by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. For extracervical myomas, the median extirpated uterine weight was 591 g (range 360–1010 g). Median duration required for placement of balloon occlusion catheter was 60 min (range 47–69 min). Median surgical duration was 98.5 min (range 77–149 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 66 min (range 42–98 min). The median estimated blood loss was 355 mL (range 50–1950 mL). For intracervical myomas, the median extirpated uterine weight was 513 g (range 302–710 g). Median duration required for placement of balloon occlusion catheter was 63 min (range 42–76 min). Median surgical duration was 96.5 min (range 92–100 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 49 min (range 44–60 min). The median estimated blood loss was 210 mL (range 150–650 mL). Transfusion of preoperatively donated autologous blood negated the need for bank blood. There were no major interventional radiological and surgical complications in the present case series. Conclusions Temporary endovascular balloon occlusion of the bilateral internal iliac arteries is a feasible minimally invasive alternative to control hemorrhage during LAVH for cervical myoma.