Uterine artery embolization immediately preceding laparoscopic myomectomy

Abstract

Objective To determine whether performing uterine artery embolization (UAE) immediately before laparoscopic myomectomy can facilitate a minimally invasive surgical approach for larger uterine fibroids. Methods In a retrospective case–control study, laparoscopic myomectomy with and without preoperative UAE was examined. Data were analyzed from 26 laparoscopic myomectomies performed by a single surgeon at Northwestern University Feinberg School of Medicine between 2004 and 2010. Controls were matched for age, calendar year, surgeon, and number of fibroids removed. Surgical outcomes included preoperative clinical uterine size, operative time, operative blood loss, and postoperative myoma specimen weight. Data were analyzed via 2-tailed Student t test. Results Twelve women underwent laparoscopic myomectomy within 169±16 minutes (mean±SEM) of preoperative UAE. Fourteen control patients underwent laparoscopic myomectomy alone. The UAE group had a greater mean preoperative clinical uterine size (19.7 versus 12.4 weeks, P<0.001) and a greater mean myoma specimen weight measured postoperatively (595.3 versus 153.6 grams, P<0.05). There were no significant differences in operative time or blood loss, and there were no intra-operative complications. Conclusion UAE performed immediately before laparoscopic myomectomy facilitated minimally invasive surgery for larger uteri and larger uterine myomas, with no differences in operative time or blood loss.

Minimally Invasive Approaches to the Surgical Management of Fibroids

“…A retrospective case-control study that compared LM with/without preoperative UAE found that the former group had a greater mean uterine size and total fibroid weight; aside from facilitating surgery for larger uteri/fibroids, there was no difference in operative time or EBL. 95 Notably, fertility after UAE remains controversial. 96,97 Some studies have shown that fertility rates as well as perinatal/obstetrical results are similar when compared with myomectomy and that ovarian failure rates are rare.…”

“…175 As noted previously, UAE is another preoperative treatment option that can facilitate removal of large uteri. 95…”

Postembolization Problems and Management

“…The patient will have the benefit of reduction of myomata, as well as the likelihood of no recurrence. UAE prior to laparoscopic myomectomy has been suggested as a way for surgeons to more safely use minimally invasive techniques for larger fibroids (Goldman et al 2011). …”

Combined myomectomy and uterine artery embolization

“…However, there are some cases where UAE alone may not be sufficient in treating patients. A combination procedure is considered (3) in the following circumstances: Large peduncuated subsersosal myoma may be considered a contraindication for UAE alone because of risks including necrosis, torsion at the stalk and separating from the uterus (4,5). Pedunculated submucous myomas are at risk of vaginal prolapse, and some authors consider UAE alone to be contraindicated in such cases (6)(7)(8).…”

“…The literature has revealed less blood loss during myomectomy procedures. With UAE prior to myomectomy, studies have shown that complications are less likely to occur (3,5). Furthermore, after UAE, with or without myomectomy, patients experience the high likelihood of no recurrence of myomata compared to myomectomy without embolization (11)(12)(13).…”