Uterine artery ligation via the laparoscope prior to myomectomy

Abstract

To the Editor:We read with interest the article by Liu et al. (1Liu W.M. Wang P.H. Chou C.S. Tang W.L. Wang I.T. Tzeng C.R. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas.Fertil Steril. 2007; 87: 356-361Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar), and commend their efforts with laparoscopic uterine artery occlusion combined with myomectomy through a minilaparotomy. We agree with the authors that uterine artery occlusion before myomectomy significantly reduces intraoperative blood loss, postoperative febrile morbidity, and secondary recurrence of leiomyomas. Uterine artery occlusion should be done via laparoscope because performing the procedure may become difficult through the minilaparotomy wound. The authors used a minilaparotomy incision for the myomectomy, but the entire procedure can be completed with the laparoscope.The review by Sesti et al. (2Sesti F. Melgrati L. Damiani A. Piccione E. Isobaric (gasless) laparoscopic uterine myomectomy—an overview.Eur J Obstet Gynecol Reprod Biol. 2006; 129: 9-14Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar) of gasless laparoscopy for myomectomy showed that conventional laparotomy instruments, such as tissue clamps, tenaculum clamps, needle holders, scalpels, and scissors can be used because the peritoneal cavity does not need to be sealed airtight. This facilitates several steps of the procedure such as enucleation of the myoma and uterine repair. Intracorporeal knot tying is used to secure the suture ends with the aid of an index finger introduced through the ancillary right access. This closure results in optimal hemostasis and strength of the uterine scar. Expensive laparoscopic instruments are not needed, and it also reduces operative cost. Electromechanical morcellation facilitates easy removal of myomas and significantly saves time (3Carter J.E. McCarus S. Time savings using the Steiner morcellator in laparoscopic myomectomy.J Am Assoc Gynecol Laparosc. 1996; 3: S6Google Scholar, 4Carter J.E. McCarus S.D. Laparoscopic myomectomy. Time and cost analysis of power vs. manual morcellation.J Reprod Med. 1997; 42: 383-388PubMed Google Scholar). We also suggest the use of gasless laparoscopy for uterine artery ligation and myomectomy.It is not clear from the authors' study how many women had infertility or recurrent pregnancy loss before myomectomy for recurrent uterine fibroids. We are hoping for further discussion and suggestions. To the Editor: We read with interest the article by Liu et al. (1Liu W.M. Wang P.H. Chou C.S. Tang W.L. Wang I.T. Tzeng C.R. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas.Fertil Steril. 2007; 87: 356-361Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar), and commend their efforts with laparoscopic uterine artery occlusion combined with myomectomy through a minilaparotomy. We agree with the authors that uterine artery occlusion before myomectomy significantly reduces intraoperative blood loss, postoperative febrile morbidity, and secondary recurrence of leiomyomas. Uterine artery occlusion should be done via laparoscope because performing the procedure may become difficult through the minilaparotomy wound. The authors used a minilaparotomy incision for the myomectomy, but the entire procedure can be completed with the laparoscope. The review by Sesti et al. (2Sesti F. Melgrati L. Damiani A. Piccione E. Isobaric (gasless) laparoscopic uterine myomectomy—an overview.Eur J Obstet Gynecol Reprod Biol. 2006; 129: 9-14Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar) of gasless laparoscopy for myomectomy showed that conventional laparotomy instruments, such as tissue clamps, tenaculum clamps, needle holders, scalpels, and scissors can be used because the peritoneal cavity does not need to be sealed airtight. This facilitates several steps of the procedure such as enucleation of the myoma and uterine repair. Intracorporeal knot tying is used to secure the suture ends with the aid of an index finger introduced through the ancillary right access. This closure results in optimal hemostasis and strength of the uterine scar. Expensive laparoscopic instruments are not needed, and it also reduces operative cost. Electromechanical morcellation facilitates easy removal of myomas and significantly saves time (3Carter J.E. McCarus S. Time savings using the Steiner morcellator in laparoscopic myomectomy.J Am Assoc Gynecol Laparosc. 1996; 3: S6Google Scholar, 4Carter J.E. McCarus S.D. Laparoscopic myomectomy. Time and cost analysis of power vs. manual morcellation.J Reprod Med. 1997; 42: 383-388PubMed Google Scholar). We also suggest the use of gasless laparoscopy for uterine artery ligation and myomectomy. It is not clear from the authors' study how many women had infertility or recurrent pregnancy loss before myomectomy for recurrent uterine fibroids. We are hoping for further discussion and suggestions. Letter to the EditorFertility and SterilityVol. 88Issue 3PreviewReply of the Authors: Full-Text PDF