Temporary clipping of the uterine artery during laparoscopic myomectomy-a new technique and the results of first cases

Bleeding is the most common complication in laparoscopic myomectomy. In this paper, we describe a new technique using Yasargil aneurysm clips to reduce blood loss during laparoscopic myomectomy by clipping the uterine arteries temporarily. Over a 7-month period, 13 patients with uterine fibroids larger than 5 cm underwent laparoscopic myomectomy with temporary clipping of both uterine arteries at their origin from the internal iliac artery. We assessed the clinical data of perioperative blood loss, operating time, hospital stay, complications, haemoglobin decrease and uterine artery Doppler flow prior to and after the procedure. No serious perioperative complications occurred. The mean number of removed fibroids was 7.5 (range 1-30), with an average total weight of 421 g (range 160-960 g). Mean Hb pre-vs. postoperatively was 12.5 g/cl vs. 10 g/cl. There was no significant change in the uterine artery flow prior to and after surgery. No transfusion was given to any of the patients. We conclude that temporary clipping of the uterine arteries prior to laparoscopic myomectomy is a safe procedure for controlling excessive blood loss without jeopardising the uterine blood supply.