A Novel Technique to Minimize Blood Loss in Robotic-Assisted Laparoscopic Myomectomy

Study Objective To evaluate the effect and feasibility of using bulldog clamps for temporary occlusion of bilateral uterine and utero-ovarian vessels on blood loss during robotic-assisted laparoscopic myomectomy. Design Retrospective chart review. Setting Academic tertiary care center. Patients or Participants A total of 15 consecutive patients, who underwent robotic-assisted laparoscopic myomectomy using bulldog clamps performed by single minimally invasive gynecologic surgeon, from 2018 to 2020. Interventions Patients were taken to the operating room for robotic-assisted laparoscopic myomectomy. Bilateral retroperitoneal dissection was performed with development of avascular spaces and ureterolysis. The uterine artery was skeletonized at its origin bilaterally and bulldog clamp was applied to each side, taking care to avoid ureteral and/or vascular injury. Furthermore, an avascular window was created in the mesosalpinx bilaterally and bulldog clamps were placed, occluding both left and right utero-ovarian vessels. Myomectomy was performed and once completed, all four clamps were removed allowing return of uterine blood flow. Measurements and Main Results Mean age and body mass index were 35.2 and 30.9 kg/m2, respectively. Most patients were black (53.3%). Mean myoma size and total myoma weight per patient were 6.6 cm and 106 g (standard deviation or SD = 82.7). Most leiomyomas were located in the fundus (41.4%). Mean estimated blood loss was 83 ml (range 20-200 ml). Mean operative time was 186 minutes. There were no intraoperative complications and all patients were discharged home on the same day of surgery. Conclusion Temporary bilateral uterine and utero-ovarian vessel occlusion using bulldog clamps can minimize blood loss during robotic-assisted laparoscopic myomectomy. Placement and removal of bulldog clamps for temporary uterine and utero-ovarian vessel occlusion are relatively easy and safe, compared to other methods of uterine artery ligation.