Hemostatic Techniques for Myomectomy: An Evidence-Based Approach

J Minim Invasive Gynecol. 2016 May-Jun;23(4):497-504. doi: 10.1016/j.jmig.2016.01.026. Epub 2016 Mar 9.

Abstract

Uterine leiomyomas are the most common benign gynecologic tumor. They are also a significant cause of morbidity, necessitating treatments ranging from hormonal suppression to surgical intervention. Myomectomy, the removal of these highly vascular tumors, offers significant quality of life and fertility-sparing benefit for patients affected by uterine leiomyomas but with a risk of substantial intraoperative blood loss. This risk of hemorrhage leads not only an increased transfusion rate but also he need for hysterectomy and other potential operative complications. Numerous medical and surgical techniques have been developed to minimize potentially significant blood loss during abdominal, laparoscopic, and robotic-assisted myomectomies. Combined with judicious preoperative assessment, these techniques substantially enhance patient safety during a myomectomy and outcomes during recovery.

Keywords: Hemostasis; Leiomyoma; Myomectomy.

Publication types

  • Review

MeSH terms

  • Administration, Intravaginal
  • Adult
  • Blood Loss, Surgical / prevention & control
  • Bupivacaine / therapeutic use
  • Drug Therapy, Combination
  • Electrosurgery / methods
  • Embolization, Therapeutic / methods
  • Epinephrine / therapeutic use
  • Female
  • Gonadotropin-Releasing Hormone / agonists
  • Hemostasis, Surgical / methods*
  • Hemostatics / therapeutic use
  • Humans
  • Hysterectomy / methods
  • Laparoscopy / methods
  • Leiomyoma / surgery*
  • Ligation
  • Oxytocin / therapeutic use
  • Prostaglandins / administration & dosage
  • Quality of Life
  • Robotic Surgical Procedures / methods
  • Suture Techniques
  • Tourniquets
  • Tranexamic Acid / therapeutic use
  • Uterine Myomectomy / methods*
  • Uterine Neoplasms / surgery*
  • Vasopressins / therapeutic use

Substances

  • Hemostatics
  • Prostaglandins
  • Vasopressins
  • Gonadotropin-Releasing Hormone
  • Oxytocin
  • Tranexamic Acid
  • Bupivacaine
  • Epinephrine