Clinical experience and fertility outcome after uterine artery occlusion and embolization

Abstract

We evaluated the effects of uterine artery occlusion and embolization on clinical results and pregnancy outcome using information provided by the literature published in the MEDLINE biomedicine database. Uterine artery occlusion has the potential to compromise fibroid growth and its symptoms. There were only a few complications and adverse events associated with laparoscopic uterine artery occlusion (LUAO) and fibroid embolization. LUAO and uterine artery embolization (UAE) procedures are both minimally invasive operating procedures that preserve the uterus and ovarian blood supply and allow achievement of pregnancy in women with symptomatic fibroids. Women who became pregnant after uterine artery occlusion and embolization had increased risk of abortion, pre-term birth, malpresentation, and/or caesarean delivery.

Clinical outcomes of magnetic resonance‐guided focused ultrasound surgery for uterine myomas: 24‐month follow‐up

“…This small number does not indicate ovarian dysfunction secondary to MRgFUS treatment. We propose that MRgFUS is a safe treatment method compared with myomectomy or UAE4–7, 19, 24.…”

“…Many minimally invasive treatments for uterine myoma are currently available, including hormonal therapy, endoscopic surgery, uterine artery embolization (UAE)1–7 and magnetic resonance‐guided focused ultrasound surgery (MRgFUS)8–19. MRgFUS involves generation of a high‐intensity ultrasound beam, which can be focused at the desired location.…”

How Do I Perform Temporary Occlusion of the Uterine Arteries During Laparoscopic Myomectomy?

“…Laparoscopic identification and occlusion of the uterine arteries require an excellent knowledge of retroperitoneal anatomy, expertise and skills [3]. Suture ligation is the standard method of controlling the uterine artery in open surgery [20].…”

“…Although a significant percentage of the patients are asymptomatic, the presence of abnormal uterine bleeding, pelvic pain and/or infertility may need therapeutic management. Myomectomy has been considered a treatment of choice for women with uterine leiomyomas who desire a safe pregnancy or wish to maintain their fertility [3].…”

“…To date, the most common choice of minimally invasive approach for large leiomyomas is the laparoscopic procedure, offering minimal postoperative discomfort, shorter hospitalization, faster return to normal activities, reduced risk of transfusion and intraabdominal adhesions [5,6]. However, laparoscopic myomectomy is a challenging procedure especially because of the potential risk of bleeding [3]. This is the most frequent intraoperative complication independently from the surgeons' experience [7].…”