Laparoscopic Vessel Clipping at Myomectomy - Uterine, Ovarian and Sampsons Artery

Video Objective To demonstrate the occlusion of three areas: the uterine artery, the round ligament and the infundibulopelvic ligament during myomectomy as a blood-sparing technique. Setting Two young patients presented with severe dysmenorrhea, AUB and subfertility. They underwent laparoscopic myomectomy, for whom the uterine artery, infundibulo-pelvic ligament and round ligament were occluded prior to the first uterine incision. Interventions After a survey, it was decided to use the lateral approach to uterine artery occlusion. The landmark was identified with traction on the medial umbilical ligament. The peritoneum was incised, and the ureter and uterine artery were exposed with careful blunt dissection. Temporary surgical clips were placed on bilateral uterine arteries. Subsequently, bilateral IP and round ligaments were similarly occluded. With devascularisation achieved, a linear incision was made over the myoma using a unipolar hook and carried through the serosa right to the myoma. Myometrium was sutured using the baseball technique. Myopia was removed by morcellation. Surgical clips were successfully removed from the uterine arteries and both IP and round ligaments. Peritoneal lavage was carried out, and Intercede barrier (Ethicon, Johnson & Johnson, Neuchatel, Switzerland) was placed. Blood loss was estimated by subtracting the instilled rinsing volume from the volume of fluid collected in the suction drain at the end of procedure. There were no post-operative complications. Conclusion Occlusion both the infundibulo-pelvic and round ligaments prior to laparoscopic myomectomy is a simple, reversible procedure, and does not significantly increase operative times. When used in conjunction with transient uterine artery occlusion, it may serve to further limit blood loss during surgery and hasten recovery. Larger studies are needed to define surgical outcomes, and recognize short and long term complications, if any.