Study Objective: To evaluate the efficacy of laparoscopic uterine artery ligation (LUAL) before in situ morcellation (ISM) compared with ISM alone. Design: Prospective study (Canadian Task Force classification II-1). Setting: University-affiliated hospital. Patients: One hundred forty-four women with symptomatic uterine myomas, of whom 45 underwent LUAL and ISM and 99 underwent ISM only, from August 2007 through August 2009. Interventions: Ligation or no ligation of the uterine arteries before ISM. Measurements and Main Results: In the LUAL+ISM group compared with the ISM group, mean (SD) operative time was significantly longer (107  minutes vs 93  minutes; p = .03), and there was less intraoperative blood loss (84  mL vs 137  mL; p < .001). Eight patients in the ISM group (8.1%) required a blood transfusion, including 4 (4.0%) with excessive intraoperative bleeding and 4 (4.0%) with postoperative hematomas. Although myomas in the LUAL+ISM group weighed more (p < .001), none of the patients in that group had excessive intraoperative bleeding, postoperative hematomas, or required blood transfusion (p = .046). At 2 years of follow-up, in the LUAL+ISM group compared with the ISM group, the myoma recurrence rate was 7% vs 24%, and symptom improvement was reported by 98% of patients vs 86% (statistically significant). Conclusion: Laparoscopic myomectomy using an ISM technique with or without simultaneous LUAL may be used in the management of symptomatic uterine myomas; however, LUAL+ISM may result in a better surgical outcome.
- In situ morcellation
- Laparoscopic uterine artery ligation
- Symptomatic myomas
ASJC Scopus subject areas
- Obstetrics and Gynaecology