Minimal Blood Loss in Robotic Assisted Laparoscopic Myomectomy: Bulldog Clamp for Temporary Ligation of Uterine Arteries and Uteroovarian Vessels

Video Objective To demonstrate how to reduce the blood loss in minimally invasive myomectomy, with using laparoscopic Bulldog clamps for ligating the uterine arteries and utero-ovarian vessels Setting 42 y/o patient with history of infertility, prior abdominal myomectomy, abnormal uterine bleeding with multiple fibroids largest one 6 cm in dimension, who underwent robotic-assisted laparoscopic myomectomy Interventions Retroperitoneal dissection and ureterolysis were performed to isolate the uterine vessels, then fallopian tubes were isolated from utero-ovarian ligaments bilaterally. Laparoscopic Bulldog clamps were used to temporarily clamp uterine arteries and utero-ovarian ligaments. Robotic Myomectomy was performed and total of 13 fibroids were removed. Uterus was repaired with 2-0 V-locks in multiple layers and reconstructed. At the completion of myomectomy the clamps were removed from the vessels. Total of estimated blood loss was 50 cc. Patient was discharged home in less than 24 hours with no complication. Conclusion Blood loss in myomectomy is related to location, and numbers of myoma. Clamping the uterine vessels and utero-ovarian can significantly reduce the blood loss. This technique requires retroperitoneal dissection and ureterolysis. Knowledge of anatomy is a master key to success.