A Randomized Trial Comparing Triple versus Single Uterine Tourniquet in Open Myomectomy

Abstract

Background: Single and triple uterine tourniquet significantly reduces blood loss during myomectomy and both are highly effective. Triple tourniquet, however, blocks ovarian circulation and there is doubt that it causes ischemic damage to ovaries. These 2 methods have not been compared by a randomised controlled study yet. The purpose of this study was to compare triple uterine tourniquet with single tourniquet in terms of blood loss during open myomectomy. Material and Methods: Womenwere randomized to triple (n = 24) or to single tourniquet (n = 24) at open myomectomy. All women with a myomatous uterus greater than 12 weeks of gestation were eligible to be part of the study. The primary outcome of the study was the amount of blood loss during surgery. Sample size was set to detect a 250 mL difference in blood loss with 80% power at α = 0.05. We also compared the change in anti-Müllerian Hormone (AMH) levels before and after surgery. Results: There was no significant difference in the outcome of blood loss between triple and single uterine tourniquet (322 ± 223 vs. 426 ± 355 mL, p = 0.230). Change in AMH was not different between the groups. Conclusions: There is no clinically significant difference between triple and single uterine tourniquets on blood loss at open myomectomy.

Uterine Reperfusion Ischemia and Use of Elastic Tourniquet

“…It is this situation that is likely to advocate tourniquet delay or any interruption of arterial circulation not exceeding 120 minutes during this type of surgery [18] The number, but also the size and locations of the myomas could also be elements that can influence the systemic expression of ischemia generated in situ by the effect of the elastic tourniquet. According to some authors, these factors considerably modify the duration of myomectomies because of their impact on the ablation of the myomas themselves [17] + G + to those of M + G −, it appears that those of ischemia did not vary between the two groups, whereas those of GPX were significantly different (p = 0.001). Compared to the basal state (control value), these results show that the plasma concentrations of ischemia markers are increased in women operated on myomas (M + G + and M + G −), but without however, differ between these two groups.…”

“…The name ischemia-reperfusion (I/R or IR) recalls that tissue damage is a direct result of hypoxia-ischemia and indirectly reperfusion-reoxygenation [6] [7] [8] [9]. Outside medical situations [1] [2] [9] [10] [11], certain types of surgeries are providers of I/R phenomena [1] [12]- [17], this is the case of the use of the tourniquet during myomectomy [17] [18] [19] [20].…”

“…Myomectomy is a surgical procedure that allows patients to retain their uterus in the context of myomatous diseases [17]- [25]. Although common [17]- [22], the removal of myomas can be complicated by severe bleeding [18]- [25].…”

“…Myomectomy is a surgical procedure that allows patients to retain their uterus in the context of myomatous diseases [17]- [25]. Although common [17]- [22], the removal of myomas can be complicated by severe bleeding [18]- [25]. Despite controversies over the use of the tourniquet (ET) during this surgery, it remains an indispensable tool for many practitioners [17]- [23] [25].…”

“…Although common [17]- [22], the removal of myomas can be complicated by severe bleeding [18]- [25]. Despite controversies over the use of the tourniquet (ET) during this surgery, it remains an indispensable tool for many practitioners [17]- [23] [25]. Indeed, its use causes a temporary stop of the blood circulation, generating a bloodless operative field and allowing a surgical comfort [18]- [26].…”