title: Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: a randomised controlled trial.
abstract: To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy.
  
  
  
  Randomised multicentre clinical trial.
  
  
  
  Tertiary-care academic centres in the USA.
  
  
  
  Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy.
  
  
  
  All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline).
  
  
  
  The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference.
  
  
  
  A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events.
  
  
  
  Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss.
  
  
  
  This randomised trial failed to show benefit of high-volume dilute vasopression.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Cohen
authors.affiliation: Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Senapati
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Gargiulo
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Srouji
authors.affiliation: Division of Gynecological Pain and Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston IL & Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
authors.forename: F F
authors.initials: FF
authors.lastname: Tu
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Solnik
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: H-C
authors.initials: HC
authors.lastname: Hur
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Vitonis
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Jonsdottir
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: K C
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Einarsson
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000008:administration & dosage* / Q000737:chemistry; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000379:methods; D014594:Uterine Neoplasms / Q000601:surgery; D014667:Vasopressins / Q000008:administration & dosage* / Q000737:chemistry
chemical_list: D006490:Hemostatics; D014667:Vasopressins
keywords: Blood loss; myomectomy; vasopressin