The Use Of Triple Tourniquets For Laparoscopic Myomectomy

Objective: The aim of this study was to assess the feasibility, safety, and effect of vascular occlusion of the uterine and ovarian arteries, on blood loss at laparoscopic myomectomy. Design: This was a pilot study. Setting: A university teaching hospital was the setting for the study. Patients: Ten women with a uterine size less than or equal to a 14-week gravid uterus were studied. Intervention: All patients had a no. 1 polyglactin suture tied around the cervix to occlude the uterine arteries and a further suture tied around the ovarian vessels. Main outcome measures: Operative blood loss, effect on ovarian function, and changes in uterine perfusion. Results: The median ultrasound diameter of the largest fibroid was 6.8 cm (range 3.8-9.8 cm). An average of three fibroids were removed (range 1-10), median total weight 209 g (range 22-318 g). The average intraoperative blood loss was 163 mL (range 33-827 mL). The median drop in day 2 hemoglobin compared to preoperative levels was 2 g/dL (range 0.7-4.5 g/dL). There was no significant difference in the resistance index of the uterine artery or in follicle stimulating hormone levels compared to baseline values. Conclusions: Vascular occlusion of the uterine blood supply using triple tourniquets to reduce intraoperative bleeding at laparoscopic myomectomy is feasible and appears to be safe.