The effect of lateral uterine artery dissection on clinical outcomes in laparoscopic myomectomy: a prospective randomized study

Abstract

This study assessed the effect of lateral uterine artery dissection (LUAD) on clinical outcomes in laparoscopic myomectomy (LM). Fifteen women with symptomatic fibroids (dominant fibroid size: 3–6 cm) were randomly allocated to laparoscopic myomectomy (group 1) and 16 women to the combined operative procedures LM and LAUD (group 2). We assessed the clinical outcomes: intra-operative and postoperative blood loss, operating time, hospital stay, hemoglobin fall, inflammatory response and tissue markers [C-reactive protein (CRP), creatinin kinase and white blood cells (WBC)]. The mean operating time was 69.5 min in group 1 and 76.5 min in the group 2, and the mean length of hospital stay was 2.6 days versus 2.1 days, respectively (P>0.05). For the laparoscopic myomectomy and combined operative procedure, respectively, the intra-operative blood loss was 134 ml (10–400 ml) and 93.7 ml (10–200 ml) (P>0.05); the difference (92.4 ml vs. 46 ml ) in estimated postoperative blood loss was statistically significant (P<0.05), and the decline in the hemoglobin level was 1.2 g/dl-1 (group 1) versus 0.6 g/dl-1 (group 2) on the 3rd postoperative day (P<0.05). Group 2 demonstrated a less intense stress response in terms of CRP (P<0.001) and WBC (P<0.01). The LUAD had little impact on intraoperative blood loss. This may be due to the smaller fibroid size, but the statistical difference in hemoglobin fall on the 3rd postoperative day was significant. The dissection of the uterine artery in laparoscopic myomectomy is a feasibile surgical procedure with a low rate of complication.