2647 ¨Uterine Arteries Ligation¨ Previous To Uterine Myomectomy (8-10 CM Myoma)

Video Objective The intention of this video is to show a different technique to ligate the uterine arteries before a large uterine myoma (8-10cm) is dissected. In that way we are decreasing the chances for bleeding. Setting This case is a 26 years old patient with a heavy bleeding y crampy abdominal pains with the periods. An ultrasound shows a large fundic myoma (8-10cm) Interventions Before do the myomectomy, the uterine arteries are ligated, using a 3-0 cromic absorbable suture. The retroperitoneal space is opened, and the anatomical structures are identified. The ureter is followed from the ileac bifurcation, then the vascular retroperitoneal anatomy is identified, the hypogastric artery becomes into the superior vesical artery and uterine artery, this is dissected and sutured with cromic 3-0, the same procedure is done in the left pelvic side wall. The uterine blood supply is decreased by almost 80%. Conclusion Temporary bilateral uterine artery occlusion during laparoscopic myomectomy does not increase mean operative time, offers a possible option to reduce blood loss effectively. This is a very easy technique to occlude temporary the vascular supply to the uterus, with this, there is no bleeding complication from the myomectomy. The main myomectomy complication is bleeding.