Role of laparoscopic uterine artery coagulation in management of symptomatic myomas: A prospective study using ultrasound and magnetic resonance imaging.
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.
Simsek
Mehmet
M
Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya and SSK Tepecik, Izmir, Turkey.
Sadik
Salih
S
Taskin
Omur
O
Guler
Hayrettin
H
Onoglu
Ahmet
A
Akar
Munire
M
Kursun
Sinan
S
Tinar
Sivekar
S
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