2953 Temporary Uterine Artery Ligation During Laparoscopic Myomectomy - Different Surgical Approaches

Video Objective Laparoscopic Uterine Artery Ligation may be performed during myomectomy in order to reduce the amount of blood loss during surgery. Setting Step-by-step video demonstration of three different techniques. Interventions Main steps of uterine artery ligation are described in detail as well as different laparoscopic variants to this procedure. Anterior Approach The impression of the uterine vessels can usually be seen anterior and laterally to the uterine cervix. After the identification of the path of the uterine arteries, the peritoneum of the anterior cul-de-sac is opened over the vessels and the uterine artery is carefully dissected next to the lateral border of the uterine cervix. This dissection must be extremely cautious because the uterine veins are very close to the artery. After the circumferential dissection of the artery, the temporary occlusion is conducted using 2-0 polyester suture. Posterior approach, lateral to the infundibulopelvic ligament For the ligation of the uterine artery posteriorly to the uterus and laterally to the pelvic infundibulum, the opening of the peritoneum of the broad ligament should start immediately below the round ligament, parallel to the external iliac vessels towards the base of the pelvic infundibulum. The avascular space is dissected by blunt dissection identifying the following landmarks: • Lateral: external iliac vessels; • Medial: pelvic infundibulum and the ureter attached to the peritoneum. The external iliac artery is dissected cranially in order to find the bifurcation of the common iliac artery and the internal iliac artery. The first medial branch of the anterior division of the internal iliac is normally the uterine artery. After dissection of the uterine artery it may be ligated according to the same technique described above. Conclusion Laparoscopic Uterine Artery legation may be performed during laparoscopic myomectomy to reduce intraoperative blood loss. According to surgical scenario, the surgeon may choose among one of the above-mentioned techniques to perform it.