The role of tourniquet in myomectomy: an observational study

Abstract

Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure. Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.

Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

“…In the present study, the duration of surgery was shorter in tourniquet group than in controls, despite the time spent on fastening and opening the tourniquet consistent with previous studies [32,36]. This indicates that myomectomy without a tourniquet is associated with complications, especially blood loss [36].…”

The Use of Vasopressor and Tourniquet to Reduce Hemorrhage during Myomectomy for Uterine Fibroid Removal: A Systematic Review

“…The uterus' blood supply is primarily from the uterine arteries, which pass through the cardinal ligament at the cervicouterine junction level, and secondarily from the ovarian arteries [18], [19]. The purpose of the tourniquet application is to occlude the blood supply to the uterus temporarily and, consequently, to the fibroid, reducing the lesion's vascularity [18]. The tourniquet is the cheapest and most accessible for our environment by far [18], [20].…”

“…The purpose of the tourniquet application is to occlude the blood supply to the uterus temporarily and, consequently, to the fibroid, reducing the lesion's vascularity [18]. The tourniquet is the cheapest and most accessible for our environment by far [18], [20]. Bonney's clamp is not universally available; vasopressin is scarce and may predispose to severe complications such as pulmonary edema, myocardial infarction, and severe hypertension [20].…”

Delayed presentation of giant uterine fibroids in a Nigerian private specialist health facility

“…The use of tourniquet applied at the base of the broad ligament during myomectomy has been very helpful in reducing blood loss and need for blood transfusion. 18 , 19 This has been the common method of minimizing blood loss during myomectomy in low-income countries as it does not need a special skill or technology to apply. Since tourniquet was used in the first case reported; it drastically helped to minimize the blood loss during the myomectomy despite the huge nature of the mass.…”