title: Role of laparoscopic uterine artery coagulation in management of symptomatic myomas: A prospective study using ultrasound and magnetic resonance imaging.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of laparoscopic uterine artery coagulation (LUC) in symptomatic myomatous patients.
  
  
  METHODS
  Prospective study (Canadian Task Force classification II).
  
  
  METHODS
  Tertiary care center
  
  
  METHODS
  Twenty-one women with myomatous uteri.
  
  
  METHODS
  Laparoscopic uterine artery coagulation.
  
  
  RESULTS
  Laparoscopic uterine artery coagulation for myoma was performed by three-puncture laparoscopy, and the difference in uterine and/or myoma volume was determined every 3 months for 12 months clinically and using ultrasonographic and MRI calculations of uterine volume. In addition, pre and postprocedure uterine Doppler indices were determined. Main outcome measures were symptomatic improvement after LUC and reduction in volume calculated by ultrasonography and magnetic resonance imaging (MRI). All treated women reported less bleeding after treatment. At 12 months, a 57% reduction in bleeding was seen in these patients. The mean postoperative pictorial blood loss assessment was significantly lower at 12 months: 303 +/- 30.4 mL (95% CI 284-328) baseline versus 173.5 +/- 17.8 mL (95% CI 164-184) after treatment, p < .05. Postoperative pain was documented in all the patients with a visual analog scale, with a mean of 1.6 cm recorded. The mean reduction in uterine volume (pre- to post-LUC) was 195 +/- 24.3 cm3 (range 89-438). The mean operating time was 52.1 +/- 7.2 minutes (95% CI 49.8-55.4), and the mean estimated blood loss was 65.2 +/- 11.8 dL (95% CI 59.6-70.8). Mean hospitalization time was 32.3 +/- 6.6 hours (95% CI 29.2-35.4). The complication rates were low with the procedure (fever, infection). No patient required hysterectomy due to complications. Ninety percent of the women were satisfied with the procedure.
  
  
  CONCLUSIONS
  Laparoscopic uterine artery coagulation is effective in the management of symptomatic myomas, reducing bleeding and the volume of both uterus and myomas as documented by ultrasonography and MRI. Laparoscopic uterine artery coagulation is a cost-effective and low-morbidity option compared with conventional approaches such as myomectomy or hysterectomy. If the patient's predominant complaint is the feeling of a mass and/or bleeding, alternative treatment options should be explored. The results of this study are encouraging, but more research is needed to validate the cost-effectiveness and long-term results.
authors.affiliation: Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya and SSK Tepecik, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Simsek
authors.forename: Salih
authors.initials: S
authors.lastname: Sadik
authors.forename: Omur
authors.initials: O
authors.lastname: Taskin
authors.forename: Hayrettin
authors.initials: H
authors.lastname: Guler
authors.forename: Ahmet
authors.initials: A
authors.lastname: Onoglu
authors.forename: Munire
authors.initials: M
authors.lastname: Akar
authors.forename: Sinan
authors.initials: S
authors.lastname: Kursun
authors.forename: Sivekar
authors.initials: S
authors.lastname: Tinar
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D018608:Ultrasonography, Doppler; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014599:Uterus / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology