The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature.
OBJECTIVE
Surgical myomectomy is currently regarded as the standard conservative treatment for patients who wish to preserve their fertility. However, it presents two main problems: the intra- and postoperative risk of bleeding and the risk of recurrence of leiomyomas. Preventive occlusion of uterine arteries was described during laparoscopic myomectomy as one of the procedures addressing these issues.


METHODS
We conducted a literature review to define the role of preventive uterine artery occlusion during laparoscopic myomectomy.


RESULTS
Nine non-randomized case-control studies and two randomized controlled trials were identified. The permanent and bilateral uterine artery occlusion technique is the most studied in the literature. The main purpose of facilitating the operative procedure by reducing blood loss has not been clearly demonstrated in randomized trials. Observational comparative studies found an improvement in the effectiveness of treatment, both on clinical symptoms and on the recurrence of leiomyomas. Finally, there are few data examining the effect of uterine artery occlusion on later fertility in female patients of childbearing age, which limits its current use.


CONCLUSIONS
The preventive occlusion of uterine arteries is a safe surgical technique that can be performed during laparoscopic myomectomy. Further randomized studies are needed to better define the role of uterine artery occlusion in the surgical strategy, especially for women who want to preserve their fertility.
Department of Gynecology and Obstetrics, University Hospitals of Geneva, 30, Boulevard de la Cluse, 1211, Geneva, Switzerland, jean.dubuisson@hcuge.ch.
J
J
Dubuisson
L
L
Ramyead
I
I
Streuli
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D055988:Uterine Artery; D055357:Uterine Artery Embolization; D063186:Uterine Myomectomy; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000098:blood supply*