Preventive Uterine Artery Occlusion: Benefits of the Laparoscopic Posterior Approach.
OBJECTIVE
To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach.


METHODS
Step-by-step explanations of the technique using videos (Canadian Task Force classification III).


METHODS
The preventive occlusion of uterine arteries during uterine surgery reduces perioperative bleeding by temporarily devascularizing the uterus. This technique, usually performed by conventional or robotically assisted laparoscopy, can be combined with surgical procedures that have a potential risk of major bleeding such as myomectomy or hysterectomy, particularly in cases of a large uterus. Here, we describe a minimally invasive technique using a laparoscopic posterior approach of the retroperitoneal space, which allows more direct access to the uterine pedicles. Institutional review board approval was obtained through our local ethics committee in Geneva University Hospitals.


METHODS
The main occlusion technique described in the literature involves a superior approach at the level of the lateral pelvic triangle. We propose to access the uterine artery via a posterior approach at the posterior and inferior level of the broad ligament. The peritoneum is opened after previous identification of the uterine artery and the ureter by transparency. After a limited dissection, the occlusion of the uterine artery is performed under direct visual control through the atraumatic placement of a 10-mm endoscopic vascular clip.


CONCLUSIONS
The posterior peritoneal approach should be favored if, during a laparoscopic procedure, a uterine artery occlusion is chosen to reduce blood loss. This technique offers an easier and a more limited dissection to access the uterine pedicles, thus minimizing the risk of accidental injuries.
Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland. Electronic address: Jean.Dubuisson@hcuge.ch.
Jean
J
Dubuisson
Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Silvia
S
Popescu
Department of Gynecology and Obstetrics, Cantonal Hospital of Fribourg, Fribourg, Switzerland.
Jean-Bernard
JB
Dubuisson
Department of Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Patrick
P
Petignat
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001956:Broad Ligament; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D017410:Practice Guidelines as Topic; D013525:Surgical Instruments; D055988:Uterine Artery / Q000503:physiopathology / Q000601:surgery*; D055357:Uterine Artery Embolization / Q000379:methods*; D014591:Uterine Diseases / Q000150:complications / Q000601:surgery*; D063186:Uterine Myomectomy / Q000379:methods; D014599:Uterus / Q000098:blood supply* / Q000601:surgery
Laparoscopy; Occlusion; Posterior approach; Uterine artery