CC BY-NC-ND 4.0 · Surg J (N Y) 2020; 06(S 01): S11-S21
DOI: 10.1055/s-0039-1693041
Precision Surgery in Obstetrics and Gynecology
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss

Satoru Takeda
1  Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
,
Tsuyoshi Ota
1  Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
,
Hiroshi Kaneda
1  Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
,
Yasuhisa Terao
1  Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
,
Ryohei Kuwatsuru
2  Department of Radiology, Faculty of Medicine, Juntendo University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
05 August 2019 (online)

  

Abstract

Abdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore, understanding of the positional relationships among a huge myoma, especially cervical or intraligamental myoma, and the vascular plexuses in the right and left cardinal ligaments is important for prevention of massive bleeding during myomectomy. While sufficiently performing preoperative assessment with pelvic examination, ultrasonography, magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they can reduce the blood loss volume, while safely and surely performing resections. For a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic space and prevent palpation and identification of the uterine arteries and the internal iliac arteries, surgery can be performed safely by preoperatively placing balloon catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and tips of subsequent pregnancy following myomectomy are also described.