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. 2025 Jan-Mar;29(1):e2024.00078.
doi: 10.4293/JSLS.2024.00078. Epub 2025 Mar 25.

Minimally Invasive Myomectomy with Temporary Bilateral Uterine Artery Blockage at Anterior Cul-de-Sac

Pengfei Wang  1   2 , Lucia Di Francesco  2 , Valmiki Seeraj  1   2 , Swati Kumari  2 , Salma Moustafa  2 , Liaisan Uzianbaeva  2 , Alireza Mehdizadeh  1   2
Affiliations

Minimally Invasive Myomectomy with Temporary Bilateral Uterine Artery Blockage at Anterior Cul-de-Sac

Pengfei Wang et al. JSLS. 2025 Jan-Mar.

Abstract

Background and objectives: Minimizing intraoperative bleeding is pivotal in myomectomy, and blockage of uterine arteries has been reported as an effective approach. We developed a novel technique to temporary occlude bilateral uterine arteries at the anterior cul-de-sac in minimally invasive myomectomy (MIS), including minilaparotomy, laparoscopic-assisted myomectomy, and laparoscopic myomectomy. This study aims to evaluate the intraoperative and postoperative outcomes of this technique in complicated myomectomy cases.

Methods: Twenty-seven patients underwent minimally invasive myomectomy by single minimally invasive surgeon using bilateral uterine arteries blockage. To match the complexity of myomectomy, 66 open cases performed by generalists were used for control.

Results: There were no significant differences in fibroid size, number, or weight between MIS and open myomectomy groups. For intraoperative outcomes, the MIS group showed longer operative time (271.3 ± 72.9 vs 179.9 ± 78.8 minutes, P < .05), but fewer cases of intraoperative blood transfusion (3% vs 17%, P < .05) and fewer intraoperative complications (0% vs 3%, P < .005). For postoperative outcomes, the MIS group demonstrated shorter hospital stay (70% vs 29% for 0-1 day; 11% vs 42% for 2 days; 19% vs 29% for 3 or more days, P < .05) and fewer postoperative complications (3% vs 9%, P < .05).

Conclusion: Temporary blockage bilateral uterine arteries enable the safe performance of complicated myomectomy via minimally invasive surgery.

Keywords: Bulldog; Minimally invasive surgery; Myomectomy; Uterine artery.

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Conflict of interest statement

Conflict of interests: none.

Figures

Figure 1.
Figure 1.
Trocar placement and incisions. (A) Laparoscopic myomectomy or LAM procedure. The 12-mm suprapubic incision will be extended for LAM after uterine arteries blockage laparoscopically. (B) Minilaparotomy.
Figure 2.
Figure 2.
Uterine artery blockage. (A and B) Lower uterine segment at medium location. (C and D) Close to umbilical artery at lateral location.
See this image and copyright information in PMC

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