Wang Pengfei, Di Francesco Lucia, Seeraj Valmiki, Kumari Swati, Moustafa Salma, Uzianbaeva Liaisan, Mehdizadeh Alireza
Department of Obstetrics and Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY. (Dr. Wang, Seeraj, and Mehdizadeh).
Department of Obstetrics and Gynecology, BronxCare Health System, Bronx, NY. (Drs. Wang, Di Francesco, Seeraj, Kumari, Moustafa, Uzianbaeva, and Mehdizadeh).
JSLS. 2025 Jan-Mar;29(1). doi: 10.4293/JSLS.2024.00078. Epub 2025 Mar 25.
Minimizing intraoperative bleeding is pivotal in myomectomy, and blockage of uterine arteries has been reported as an effective approach. We developed a novel technique to temporary occlude bilateral uterine arteries at the anterior cul-de-sac in minimally invasive myomectomy (MIS), including minilaparotomy, laparoscopic-assisted myomectomy, and laparoscopic myomectomy. This study aims to evaluate the intraoperative and postoperative outcomes of this technique in complicated myomectomy cases.
Twenty-seven patients underwent minimally invasive myomectomy by single minimally invasive surgeon using bilateral uterine arteries blockage. To match the complexity of myomectomy, 66 open cases performed by generalists were used for control.
There were no significant differences in fibroid size, number, or weight between MIS and open myomectomy groups. For intraoperative outcomes, the MIS group showed longer operative time (271.3 ± 72.9 vs 179.9 ± 78.8 minutes, < .05), but fewer cases of intraoperative blood transfusion (3% vs 17%, < .05) and fewer intraoperative complications (0% vs 3%, < .005). For postoperative outcomes, the MIS group demonstrated shorter hospital stay (70% vs 29% for 0-1 day; 11% vs 42% for 2 days; 19% vs 29% for 3 or more days, < .05) and fewer postoperative complications (3% vs 9%, < .05).
Temporary blockage bilateral uterine arteries enable the safe performance of complicated myomectomy via minimally invasive surgery.
在子宫肌瘤切除术中，尽量减少术中出血至关重要，据报道阻断子宫动脉是一种有效的方法。我们开发了一种新技术，用于在微创子宫肌瘤切除术（包括小切口剖腹术、腹腔镜辅助子宫肌瘤切除术和腹腔镜子宫肌瘤切除术）中在阴道后穹窿临时阻断双侧子宫动脉。本研究旨在评估该技术在复杂子宫肌瘤切除病例中的术中及术后结果。
27例患者由单一微创外科医生采用双侧子宫动脉阻断术进行微创子宫肌瘤切除术。为匹配子宫肌瘤切除术的复杂性，选取66例由普通外科医生进行的开腹手术病例作为对照。
微创组和开腹子宫肌瘤切除组在肌瘤大小、数量或重量方面无显著差异。在术中结果方面，微创组手术时间更长（271.3±72.9分钟对179.9±78.8分钟，P<0.05），但术中输血病例较少（3%对17%，P<0.05），术中并发症也较少（0%对3%，P<0.005）。在术后结果方面，微创组住院时间更短（0 - 1天：70%对29%；2天：11%对42%；3天或更长时间：19%对29%，P<0.05），术后并发症也较少（3%对9%，P<0.05）。
临时阻断双侧子宫动脉可使复杂子宫肌瘤切除术通过微创手术安全进行。
