The Use of Uterine Tourniquet to Decrease Blood Loss and Transfusion Rate during Myomectomy: A Systematic Review and Meta-Analysis.

Abstract

<h3>Study Objective</h3> To determine the impact of uterine tourniquet on blood loss and transfusion rates during myomectomy. <h3>Design</h3> This study is a systematic review and meta-analysis. Electronic databases were searched from inception until October 3, 2020, for relevant articles. <h3>Setting</h3> Two reviewers independently screened all studies and extracted the data for the meta-analysis. <h3>Patients or Participants</h3> Studies involving pre-menopausal patients with benign, symptomatic uterine fibroids undergoing open, laparoscopic, or robotic myomectomy were included. Studies with pregnant or postmenopausal patients were excluded. <h3>Interventions</h3> Use of a tourniquet around the uterine isthmus and/or the infundibulopelvic ligament compared to control group which received no blood conservation intervention. <h3>Measurements and Main Results</h3> Five studies published between 2005 to 2020 were included, involving a total of 369 patients. 198 patients had a tourniquet used intra-operatively. All patients underwent open myomectomy. Three studies were randomized control trials and two were retrospective cohort studies. Estimated blood loss was significantly lower in the tourniquet group, with an effect size of 330 mL, z = 4.35, p < 0.001. 7% (14 out of 198) of patients received transfusion in the tourniquet group and 21% (36 out of 171) of patients received transfusion in the control group, the decrease in post op transfusion is at the border of statistical significance, z = 1.95, p = 0.05. Operative time and complications were not significantly different between the two groups. Overall, the included studies had a high risk of bias and large heterogeneity. <h3>Conclusion</h3> The use of uterine tourniquet at the time of abdominal myomectomy decreases blood loss and may decrease post operative transfusion. The intervention is inexpensive, simple and does not increase operative time or complications. Further high-quality research is needed.