Laparoscopic myomectomy using endoscopic loops under progressive tension

Abstract

The Authors describe a novel technique for laparoscopic myomectomy of fibroids with a subserosal component which involves the use of endoscopic loops under progressive tension to avoid bleeding, facilitate enucleation and possibly reduce the need of conventional sutures. Data analysis from a series of 34 consecutive operations shows that the use of endoloops helps achieving a good haemostasis, and no case of haemorrhage from the fibroid bed was ever recorded. Moreover, the need of diathermy was reduced, and the enucleation of the fibroids resulted facilitated by a bloodless field and the squeezing effect induced by the progressive tension on the loops. Although a reduction of number of traditional suturing was recorded, we do not recommend this technique to surgeons who are not familiar with conventional laparoscopic suturing. Overall, the suggested use of endoscopic loops seems to facilitate laparoscopic myomectomy on fibroids with at least a partial subserosal component. We believe that this method deserves comparative studies in order to furtherly demonstrate its safety and efficacy.

Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

“…In case of myomectomies for intramural fibroids, intraoperative techniques to reduce bleeding, such as those by endoscopic loops or ligations [ 48 – 50 ], might be preferable over preoperative UAE [ 22 ]. Identification and separate suturing of different layers, especially in case of opening of the endometrial cavity, is recommendable.…”

Laparoscopic myomectomy – The importance of surgical techniques

“…Intracorporeal or extracorporeal knots can be used if tension is maintained. Preformed disposable endoscopic loops can be used if a progressive tie can be realized ( 41 ). If enucleation is achieved, the endoloop is tied and offers mechanical hemostasis, as well as a good exposure of the cleavage plane.…”

“…If enucleation is achieved, the endoloop is tied and offers mechanical hemostasis, as well as a good exposure of the cleavage plane. Studies have shown a reduction in diathermy, thus improving scar quality ( 41 ). The “bottom-up suture” technique was proposed for better suturing by elevating the bed of the myoma while still attached to the uterus ( 42 ); advantages of this technique include hemorrhage control and prevention of dead-space formation.…”

Endoscopic loops for laparoscopic myomectomy

“…For instance, commercial loops can be used successfully directly on the serosa and myometrium surrounding the base of subserosal fibroids (5). The application of such loops before the incision on the serosa, and their progressive tightening, reduces blood loss from perimyomatous vessels globally and also facilitates the enucleation thanks to a ''squeezing'' effect on the myometrium.…”