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Preventive Uterine Artery Occlusion: Benefits of the Laparoscopic Posterior Approach.
- Source :
-
Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2016 Mar-Apr; Vol. 23 (3), pp. 296. Date of Electronic Publication: 2015 Aug 31. - Publication Year :
- 2016
-
Abstract
- Study Objective: To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach.<br />Design: Step-by-step explanations of the technique using videos (Canadian Task Force classification III).<br />Setting: 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.<br />Interventions: 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.<br />Conclusion: 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.<br /> (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Broad Ligament
Female
Humans
Hysterectomy methods
Practice Guidelines as Topic
Surgical Instruments
Uterine Artery physiopathology
Uterine Diseases complications
Uterine Myomectomy methods
Uterus surgery
Blood Loss, Surgical prevention & control
Laparoscopy methods
Uterine Artery surgery
Uterine Artery Embolization methods
Uterine Diseases surgery
Uterus blood supply
Subjects
Details
- Language :
- English
- ISSN :
- 1553-4669
- Volume :
- 23
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of minimally invasive gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 26334789
- Full Text :
- https://doi.org/10.1016/j.jmig.2015.08.885