Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: A systematic review and meta-analysis of 11 controlled trials

Alomar, Osama; Abu‐Zaid, Ahmed; Jamjoom, Mohammed Ziad; Almubarki, Abdullah AMA; Alsehaimi, Saud Owaimer; Alabdrabalamir, Safa; Baradwan, Saeed; Abuzaid, Mohammed; Alshahrani, Majed Saeed; Khadawardi, Khalid; Badghish, Ehab; Bakhsh, Hanadi; Baalharith, Maha Al; Bukhari, Ibtihal Abdulaziz; Baradwan, Afnan; Salem, Hany; Al‐Badawi, Ismail A.

doi:10.1016/j.jogoh.2022.102485

Cited by 8 publications

(6 citation statements)

References 39 publications

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“…However, in this study, three gynecologic surgeons (SJP, EJL and HSK) who had completed a gynecologic fellowship program and had performed open and laparoscopic myomectomy for more than three years performed conventional RALM with four trocars and barbed suture, so it is not expected that the difference in surgical technique is significant; Second, we did not establish a control group with no treatment for hemostasis as a comparison. Since vasopressin is already known to be effective for hemostasis during myomectomy, a control group without the treatment could not be established in this study because it would have raised issues related to human subjects' risk of harm in the design phase (18). As an alternative, it is considered preferable to establish a control group in future trials using other methods of hemostasis, such as tourniquets and rectal misoprostol (14,19): Third, the number of subjects was too small to generalize the results of this study despite being a randomized controlled pilot trial.…”

Section: Complications (N %)mentioning

confidence: 99%

Effect and Safety of Diluted Vasopressin Injection for Bleeding Control During Robot-assisted Laparoscopic Myomectomy in Reproductive Women With Uterine Fibroids: A Randomized Controlled Pilot Trial (VALENTINE Trial)

PARK,

LEE,

HWANG

et al. 2023

In Vivo

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Background/Aim: Vasopressin injected during myomectomy is known to effectively reduce bleeding but is sometimes associated with intraoperative vasoconstriction and hypertension due to systemic absorption. Although there is a growing preference for the use of diluted vasopressin, evidence of its effect and safety is still lacking. Patients and Methods: We performed a randomized controlled pilot trial to evaluate the effect and safety of vasopressin diluted in a constant volume during robot-assisted laparoscopic myomectomy (RALM), where a total of 39 women with uterine fibroids were randomly assigned into the following three groups (group 1, 0.2 IU/ml; group 2, 0.1 IU/ml; group 3, 0.05 IU/ml with a total of 100 ml of normal saline). The primary endpoint was to compare estimated blood loss (EBL), and the secondary endpoints were to compare postoperative value and drop ratio of hemoglobin, operation time, transfusion, hospitalization, and complications among the three groups. Results: There were no differences in the number and largest size of uterine fibroids, total weight of uterine fibroids, console time, and volumes of intravenous fluid administered during RALM among the three groups, whereas combined operation was performed more commonly in group 2 than in groups 1 and 3 (53.9% vs. 0 to 7.7%; p=0.01). The primary and secondary endpoints were also not different among the three groups. However, two patients in group 1 (15.4%) showed vasopressin-related hypertension. Conclusion: Vasopressin diluted in a volume of 100 ml showed an effective hemostatic effect and safety during RALM (Trial No. NCT04874246 in ClinicalTrial.gov).Uterine fibroids are the most common benign gynecologic condition in women, diagnosed in more than 25% of women of childbearing age. Despite its benign nature, uterine fibroids are associated with clinical symptoms, such as abnormal uterine bleeding, pain, and pressure in 25-50% of women, so there is still an ongoing clinical interest in effective treatment (1). Pharmacotherapy with non-steroidal anti-inflammatory drugs, hormonal agents, and gonadotropin-releasing hormone (GnRH) agonists is the first line of treatment for symptomatic uterine fibroids and invasive procedures, such as uterine artery embolization, or high-intensity focused ultrasound may be considered if there is a lack of response to the medical 431

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Section: Complications (N %)mentioning

confidence: 99%

Effect and Safety of Diluted Vasopressin Injection for Bleeding Control During Robot-assisted Laparoscopic Myomectomy in Reproductive Women With Uterine Fibroids: A Randomized Controlled Pilot Trial (VALENTINE Trial)

PARK,

LEE,

HWANG

et al. 2023

In Vivo

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“…Overall, the present meta-analysis does not seem to recommend the use of ascorbic acid as an antihemorrhagic agent among patients undergoing myomectomy. Evidence from previous meta-analyses showed the clinical efficacy of several antihemorrhagic agents, such as oxytocin/carbetocin [ 24 ], tranexamic acid [ 25 ], and vasopressin [ 6 ], during myomectomy. Hence, future investigations may include a direct comparison between ascorbic acid and other active comparators (e.g., oxytocin/carbetocin, tranexamic acid, and vasopressin).…”

Section: Reviewmentioning

confidence: 99%

“…Intraoperative hemorrhage is frequent [ 4 ], and it may necessitate blood transfusion [ 5 ]. Unbalanced hemostasis, circulatory collapse, and death are rare but serious bleeding-associated complications during myomectomy [ 6 ]. Overall, interventions to mitigate the magnitude of bleeding and related complications during myomectomy are considerably important.…”

Section: Introductionmentioning

confidence: 99%

Ascorbic Acid for Prevention of Intraoperative Blood Loss and Related Complications During Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abu‐Zaid¹,

Alrashidi²,

Almouh³

et al. 2022

Cureus

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Leiomyomas are inherently well-vascularized neoplasms; thus, they are very vulnerable to bleedingassociated complications during myomectomy. Ascorbic acid has well-established functions in tissue healing and the prevention of bleeding tendencies. Several randomized controlled trials (RCTs) have explored the antihemorrhagic utility of ascorbic acid administration during myomectomy. This research aimed to systematically and meta-analytically summarize the clinical antihemorrhagic efficacy of ascorbic acid (i.e., the intervention arm) versus placebo/no treatment (i.e., the control arm) during myomectomy. We electronically searched six sources, i.e., PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar. Our search was from inception until October 2022. We used the Cochrane Risk of Bias Scale (version 2) to assess the quality of the included studies. We summarized the effect sizes as the mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in a fixedeffects or random-effects model. Overall, three RCTs met the inclusion criteria, comprising a total of 193 patients: 99 patients were allocated to the ascorbic acid arm, whereas 94 patients were allocated to the control arm. The overall study quality was "low" and "some concerns" risk of bias in two and one RCT(s), respectively. There was no significant difference between the ascorbic acid and control arms regarding the mean intraoperative blood loss (n=2 RCTs, MD = −190.29 ml, 95% CI [−626.62, 246.05], p=0.39) and mean change in hemoglobin level (n=3 RCTs, MD = −0.26 mg/dl, 95% CI [−0.56, 0.04], p=0.09), respectively. Conversely, the ascorbic acid arm had statistically significant reductions in the mean operative time (n=3 RCTs, MD = −24.10 min, 95% CI [−30.67, −17.53], p<0.001) and the rate of blood transfusion (n=3 RCTs, RR=0.36, 95% CI [0.15, 0.87], p=0.02) compared with the control arm. No serious adverse events related to ascorbic acid were identified. In conclusion, ascorbic acid administration was associated with several beneficial effects, including reductions in mean operative time and rate of blood transfusion, but without affecting the mean intraoperative blood loss and mean change in hemoglobin level. In view of the limitations of the present meta-analysis, the use of ascorbic acid as an antihemorrhagic additive among patients undergoing myomectomy is not strongly recommended.

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“…Surgical treatment, including hysterectomy or myomectomy, remains the most definitive and effective treatment for symptomatic uterine fibroids 11 12. Myomectomy removes the fibroids while preserving the uterus and is commonly performed in women who wish to maintain fertility 13 14. However, myomectomy can be associated with significant blood loss and prolonged operative time, and the recurrence rate is relatively high 15.…”

Section: Introductionmentioning

confidence: 99%

“… 11 12 Myomectomy removes the fibroids while preserving the uterus and is commonly performed in women who wish to maintain fertility. 13 14 However, myomectomy can be associated with significant blood loss and prolonged operative time, and the recurrence rate is relatively high. 15 Open abdominal myomectomy is still the gold standard for myomectomy, while the laparoscopic or robotic-assisted myomectomy allows for better visualisation and control of bleeding, and may be preferred for larger, more complex fibroids.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

Shi,

Wu,

Liu

et al. 2024

BMJ Open

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ObjectiveThis study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence.DesignA retrospective cohort study.SettingFollowing strengthening the reporting of observational studies in epidemiology (STROBE) criteria, a retrospective study of prospectively collected available data of the consecutive patients who underwent the myomectomy in the department of obstetrics and gynaecology of the single centre between February 2018 and December 2020.Participants177 patients who underwent laparoscopic myomectomy resection were enrolled in the present cohort study.Materials and methodsPatients were classified into two groups according to their different methods of haemostasis in laparoscopic surgery. Recurrence-free survival was compared between the groups during an average follow-up of nearly 2 years.ResultsOf the 177 patients from 672 consecutive patients in the retrospective cohort, laparoscopic circular suture and baseball suture were carried out in 102 (57.6%) and 75 (42.4%) patients, respectively. The total amount of blood lost during surgery varied significantly (37.6 vs 99.5 mL) (p<0.001). Univariable analyses identified that age ≥40 years, position at intramural myoma, multiple fibroids and largest fibroid volume ≥50 mm3(HR 2.222, 95% CI 1.376 to 3.977, p=0.039; HR 3.625, 95% CI 1.526 to 6.985, p=0.003; HR 3.139, 95% CI 1.651 to 5.968, p<0.001; HR 2.328, 95% CI 0.869 to 3.244, p=0.040, respectively) are independent risk factor of the recurrence of uterine fibroids. The formula of the nomogram prediction model was established as the practical clinical tool.ConclusionThe laparoscopic continuous seromuscular circumsuture for myomectomy can effectively reduce the amount of surgical bleeding and accelerate the perioperative recovery for surgical safety. The main factors affecting the recurrence of uterine fibroids were age, location, number and volume of uterine fibroids. The nomogram can more straightforwardly assist clinicians to determine the risk of recurrence after laparoscopic myomectomy.

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Prophylactic vasopressin to reduce intraoperative blood loss and associated morbidities during myomectomy: A systematic review and meta-analysis of 11 controlled trials

Cited by 8 publications

References 39 publications

Effect and Safety of Diluted Vasopressin Injection for Bleeding Control During Robot-assisted Laparoscopic Myomectomy in Reproductive Women With Uterine Fibroids: A Randomized Controlled Pilot Trial (VALENTINE Trial)

Effect and Safety of Diluted Vasopressin Injection for Bleeding Control During Robot-assisted Laparoscopic Myomectomy in Reproductive Women With Uterine Fibroids: A Randomized Controlled Pilot Trial (VALENTINE Trial)

Ascorbic Acid for Prevention of Intraoperative Blood Loss and Related Complications During Myomectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

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