Temporary Uterine Artery Occlusion Research Articles

An innovative approach in the treatment of nodular adenomyosis

Introduction. The necessity to improve methods of adenomyosis treatment is determined not only by its high prevalence, which reaches 40 % among women of reproductive age, but also by its association with infertility of unclear genesis. The disease significantly reduces the quality of life. Objective. To optimize reproductive outcomes after surgical treatment of nodular adenomyosis and to prevent the disease recurrence. Materials and Methods. A cohort prospective comparative study examined the efficacy of therapy with dienogestam after laparoscopic removal of adenomyosis nodules with temporary uterine artery occlusion and temporary balloon occlusion of the internal iliac arteries. The study included 25 women who underwent organ-preserving treatment for nodular adenomyosis from January 1, 2020 to January 1, 2022. Inclusion criteria: age 22–45 years, mean 32 ± 4.5; organ preserving treatment for nodular adenomyosis, no contraindications to hormone therapy, informed voluntary consent of the patient to participate in the study. Results. The use of Dientogest at a dose of 2 mg/day in a continuous regimen for 6 months after surgical treatment for nodular adenomyosis was shown to transform the intensity of pain syndrome to insignificant, the absence of recurrent disease for 24 months of follow-up. Conclusions. The comprehensive treatment of nodular adenomyosis, which included laparoscopic removal of the nodule and the drug therapy with dienogestam, permitted the achievement of reproductive function in 40% of the patients. The choice of the treatment method for nodular adenomyosis depends primarily on the reproductive plans of the patient, the size and location of the adenomyosis nodules, and its long-term results depend on the comprehensive antiretroviral therapy.

Laparoscopic myomectomy of a lateral cervical fibroid with temporary uterine artery occlusion

Laparoscopic myomectomy of a lateral cervical fibroid with temporary uterine artery occlusion

Temporary Uterine Artery Occlusion and Surgical Techniques for Stage 4 Endometriosis

<h3>Study Objective</h3> To describe a surgical approach to minimize intraoperative blood loss and improve visualization for stage 4 endometriosis. <h3>Design</h3> Video presentation for surgical management of stage 4 endometriosis. <h3>Setting</h3> The procedure was performed with robot assisted laparoscopy in dorsal lithotomy position. <h3>Patients or Participants</h3> A 39-year-old patient G0 with stage 4 endometriosis and prior failed In Vitro Fertilization. <h3>Interventions</h3> In this Video we describe the surgical approach used for Stage 4 endometriosis after prior failed In Vitro Fertilization. Intraoperatively, Initial survey of the pelvis showed both small and large bowel adhesions to the posterior aspect of the uterus as well as obliteration of the cul-de-sac. We begin by opening the pelvic sidewall bilaterally, parallel and lateral to the infundibulopelvic ligament identifying the pararectal space. The ureters are identified bilaterally and are tagged with a vessel loop for easier identification and manipulation for ureterolysis. Further dissection into the pararectal space is performed to identify the uterine arteries at their origin and are temporarily ligated with vascular bulldog clamps. Ureterolysis is then performed followed by mobilization of the rectum using a lateral to medial approach towards the central pathology. The anatomy of the adnexa is then restored bilaterally and a bilateral salpingectomy was then performed due to hydrosalpinx to improve future attempts of In Vitro Fertilization. The vascular bulldog clamps are then removed at the end of the procedure. <h3>Measurements and Main Results</h3> Patient had significant improvement in pain post operatively and is pending In Vitro Fertilization. <h3>Conclusion</h3> Temporary uterine artery ligation during extensive endometriosis surgery could improve blood loss and visualization intraoperatively and can be utilized during pelvic side wall dissection and identification of critical anatomy.

Temporary uterine artery occlusion with a Nelaton catheter reduces bleeding during laparoscopic myomectomy for cervical fibroids

Laparoscopic myomectomy (LM) is currently widely used as surgical treatment for uterine fibroids; however, it may be technically challenging in some patients with cervical fibroids in whom laparotomy needs to be performed. Reportedly, preoperative uterine artery embolization and intraoperative cutting and ligation of the uterine artery reduce intraoperative bleeding during myomectomies. Notably, maintaining maximal uterine blood flow is necessary in patients who desire fertility preservation; unfortunately, currently, no such method is available.

Temporary Uterine Artery Occlusion at Laparoscopic Myomectomy – A Simple Technique to Reduce Blood Loss

Video Objective Demonstrate a simple, temporary and reversible method for uterine artery occlusion at the time of laparoscopic myomectomy Setting Tertiary level Academic center. Interventions Temporary uterine artery occlusion has been shown to reduce blood loss at myomectomy. The technique demonstrated shows a simple approach for using laparoscopic bulldog clamps at myomectomy Conclusion To reduce intraoperative blood loss for women undergoing laparoscopic myomectomy: Intra-myometrial injection of dilute vasopressin, Temporary placement of uterine artery clamps, Tranexamic acid, Misoprostol (PGE1).

1189 Intraoperative Strategies to Minimize Blood Loss During Myomectomy

Video Objective Fibroids are common, benign masses which can result in significant morbidity for affected women due to heavy menstrual bleeding and anemia, bulk symptoms and infertility. In women who are pre-menopausal or wishing to retain future fertility, the surgical management of symptomatic fibroids is by way of myomectomy. The surgical removal of fibroids can be associated with significant intraoperative blood loss and subsequent blood transfusion, which is an important morbidity associated with this elective procedure in reproductive-aged women. Gynecologic surgeons have utilized a number of interventions in an attempt to reduce rates of surgical bleeding during myomectomy but clinical practice varies considerably. This video demonstrates various evidence-based strategies aimed at minimizing surgical bleeding during myomectomy. Setting N/A Interventions Techniques covered in this video include: (1) Preoperative use of medications such as vaginal/rectal misoprostal and intravenous tranexamic acid, (2) Intramyometrial injection of dilute vasopressin and (3) Temporary uterine artery occlusion with pericervical tourniquet. Conclusion Intraoperative blood loss is a significant surgical risk during laparoscopic, robotic and abdominal myomectomy and perioperative transfusion rates are high. There are significant short-term and long-term risks associated with blood transfusion and gynecologic surgeons must employ evidence-based interventions in order to minimize blood loss and decrease the need for blood transfusions.

Uterine Arteries Temporary Occlusion during Laparoscopic Myomectomy

To demonstrate the topographic anatomy and the surgical technique applied to perform the uterine artery temporary occlusion during laparoscopic myomectomy. Patient: Female, 41 years old, no previous pregnancy, complaining of menorrhagia and pelvic pain. Clinical investigation with Tranvaginal ultrasonography and MRI identified multiple myomas in a hyper vascularized utherus. Results: A step-by-step surgical procedure was performed.Laparoscopic surgery with anatomical retroperitoneal dissection and temporary uterine arteries occlusion was performed. Conclusion: Temporary uterine artery occlusion can be used to reduce intraopeative bleeding and allow minimally invasive treatment of multiple myomas.

Non-Surgical Treatment Options for Symptomatic Uterine Leiomyomas

Uterine leiomyomas (or uterine fibroids), benign tumors of the uterine smooth muscle cells, can cause significant morbidity and impair quality of life in many women. For those who are asymptomatic, watchful waiting constitutes appropriate management. For women with symptomatic fibroids, hysterectomy and myomectomy are traditionally the standard treatments. In the last two decades, many alternatives to surgery for the management of fibroids have been developed. Most of the current medical treatments involve hormone manipulation. Newer treatments such as mifepristone, asoprisnil and aromatase inhibitors show promising results in fibroid symptom and size reduction; however, larger studies are needed. A safe and effective therapy as an alternative to hysterectomy is uterine artery embolization (UAE), which offers shorter recovery times and fewer major complications, though fertility and pregnancy outcomes after a UAE may be affected. Limited data are available for the efficacy and safety of temporary uterine artery occlusion. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is the newest treatment option for uterine fibroids. It also shows promising results for symptom relief. The degree of symptom relief depends significantly on the amount of fibroid volume that is non-perfused after treatment and the experience of the physician performing the procedure. Keywords: Fibroids, hormones, NSAIDs, progestins, oral contraceptives, mifepristone, asoprisnil, gonadotropin-releasing hormone agonists, uterine artery embolization, selective estrogen receptor modulators, transvaginal temporary uterine artery occlusion, magnetic resonance-guided focused ultrasound surgery

Treatment of Uterine Myomas with Transvaginal Uterine Artery Occlusion: Possibilities and Limitations

The objective of this pilot study was to evaluate the feasibility of a transvaginal clamp prototype used for temporary uterine artery occlusion as a treatment for myomas. In particular, we aimed to evaluate technical aspects of successful occlusion with angiography and magnetic resonance imaging (MRI) and to evaluate possible ureter occlusion with pyelography. Ten premenopausal women aged 34 to 37 years with menorrhagia and myomas were treated with a temporary uterine artery occlusion for 6 hours. Five patients did not complete the clamping procedure because of unsuccessful clamping. While the clamp was in position, angiographic examination of the uterine arteries and pyelography were performed in 8 of the patients. The clamps occluded both uterine arteries in 4 patients and 1 side in another 2. Two procedures occluded the ureter unilaterally. MRI with contrast was done before, the day after, and 3 months after the procedure. Three of 5 patients who completed the clamp treatment had reduced or no contrast enhancement at MRI afterward. Clinical effects were obtained in 3 patients. Difficulties with application of the vaginal clamp were related to initial learning and size of the myomas. Our initial experience shows that the treatment is feasible in some patients with symptomatic myomas. However, improvement of the technique and equipment is needed. Care with regard to the ureters is required during further studies aimed at evaluating this approach.

Non-surgical management of uterine fibroids

Efforts to develop alternatives to surgery for management of symptomatic uterine fibroids have provided new techniques and new medications. This review summarizes the existing literature on uterine artery embolization (UAE) and investigational studies on four newer approaches. PubMed, Cochrane and Embase were searched up to December 2007. Studies reporting side-effects and complications and presenting numerical data on at least one outcome measure were included. Case studies report 50-60% reduction in fibroid size and 85-95% relief of symptoms following UAE. The largest of these studies reported an in-hospital complication rate of 2.7% (90 of 3041 patients) and a post-discharge complication rate of 26% (710 of 2729 patients). Eight studies compared UAE with conventional surgery. Best evidence suggested that UAE offered shorter hospital stays (1-2 days UAE versus 5-5.8 days surgery, 3 randomized controlled trials (RCTs)) and recovery times (9.5-28 days UAE versus 36.2-63 days surgery, 3 RCTs) and similar major complication rates (2-15% UAE versus 2.7-20% surgery, 3 RCTs). Four studies analysing cost-effectiveness found UAE more cost-effective than surgery. There is insufficient evidence regarding fertility and pregnancy outcome after UAE. Five feasibility studies after transvaginal temporary uterine artery occlusion in 75 women showed a 40-50% reduction in fibroid volume and two early studies using magnetic resonance guided-focused ultrasound showed symptom relief at 6 months in 71% of 109 women. Two small RCTs assessing mifepristone and asoprisnil showed promising results. Good quality evidence supports the safety and effectiveness of UAE for women with symptomatic fibroids. The current available data are insufficient to routinely offer UAE to women who wish to preserve or enhance their fertility. Newer treatments are still investigational.

Possibility of hidden damages with temporary uterine artery occlusion device

Possibility of hidden damages with temporary uterine artery occlusion device

Reply: Possibility of hidden damages with temporary uterine artery occlusion device

Reply: Possibility of hidden damages with temporary uterine artery occlusion device

Nonsurgical Temporary Uterine Artery Occlusion for Leiomyomata

Vilos, George A. MD; Vilos, Emily C. BA; Abu-Rafea, Basim MD; Hollett-Caines, Jackie MD; Romano, Walter MD Author Information

200: Fibroid Treatment by Temporary Uterine Artery Occlusion Using a Doppler Guided Clamp

To assess the effectiveness of temporary uterine artery occlusion in reducing uterine and fibroid volume in patients with symptomatic fibroids. An ethics committee approved study to evaluate the technical success of a transvaginal uterine artery occlusion system (technical success=vessels occluded for duration of target time). All patients have been offered hysterectomy as part of this study but we have follow-up on a series of 22 patients who have elected not to have a second procedure. A university medical center. A consecutive series of 22 patients with symptomatic uterine fibroids treated from June 2004 through March 2005. All patients were prescreened with MR imaging to verify fibroid number, position, and overall uterine volume. The uterine arteries of these patients are then temporarily occluded for a period of four to seven hours with a transvaginal Doppler guided clamp. Success of occlusion is verified using the integrated Doppler and confirmed with angiography. Of the 22 patients in this series, 9 have returned for follow-up MR imaging. The range of follow-up is 4.2 to 7.8 months post procedure. Of these 9 patients, 7 demonstrate decreasing uterine and fibroid volumes. Average uterine volume decrease is 18.4% and average fibroid volume decrease 55.6%. This easy to use device has demonstrated success in reducing uterine and fibroid volumes in these patients and more importantly has delayed any further interventions required for relief for symptoms.

133: Temporary Uterine Artery Occlusion for the Treatment of Symptomatic Leiomyomas—The Findings of Two Pilot Studies

133: Temporary Uterine Artery Occlusion for the Treatment of Symptomatic Leiomyomas—The Findings of Two Pilot Studies

Temporary uterine artery occlusion for treatment of menorrhagia and uterine fibroids using an incisionless Doppler-guided transvaginal clamp: Case report

We report the successful treatment of a 43-year-old woman with menorrhagia and multiple uterine fibroids by temporary uterine artery occlusion. Using a Doppler-guided transvaginal clamp, her uterine arteries were non-invasively identified and occluded by mechanical compression against the cervix for 6 h. Following removal of the clamp, blood flow in the uterine arteries returned immediately. Menorrhagia symptoms were tracked with the Ruta Menorrhagia Severity Scale. Uterine and fibroid volumes were measured by analysis of magnetic resonance images. The patient's self-reported menorrhagia symptoms were significantly reduced at 6 months (70% reduction in Ruta score) and both uterine volume and fibroid volume had decreased by more than 44% at 6 months. This case report illustrates the potential applicability of a simple-to-use, non-surgical device for the treatment of menorrhagia and uterine fibroids by temporary uterine artery occlusion.

Temporary Uterine Artery Occlusion Using a Variable Occlusion Time in the Treatment of Symptomatic Leiomyomas

Temporary Uterine Artery Occlusion Using a Variable Occlusion Time in the Treatment of Symptomatic Leiomyomas

Assessment of feasibility and safety of temporary uterine artery occlusion for treatment of symptomatic uterine fibroids

To assess the feasibility and safety of temporary bilateral uterine artery occlusion performed with intravaginal application of a paracervical clamp with integrated audible Doppler ultrasound for treatment of symptomatic uterine fibroids.

Intravaginal temporary uterine artery occlusion for treatment of menorrhagia and fibroids using a paracervical clamp: A case report

Intravaginal temporary uterine artery occlusion for treatment of menorrhagia and fibroids using a paracervical clamp: A case report