In this video, we demonstrate three approaches to uterine artery occlusion at time of laparoscopic myomectomy as a blood-sparing intra-operative technique. A step-wise approach is applied prior to beginning the myomectomy which includes the following:
1) Selecting the appropriate approach to uterine artery occlusion (lateral vs. posterior vs. anterior) based on individual anatomy;
2) identification of relevant anatomy and important landmarks for the procedure
3) isolating the uterine artery and identifying the ureter;
4) occluding the uterine artery.
As illustrated in this video, uterine artery occlusion can be performed by three different approaches, depending on both surgeon preference and unique patient anatomy. A systematic review and meta-analysis of the literature supports the efficacy of this procedure in terms of limiting blood loss, blood transfusion, and fibroid recurrence, albeit at slightly longer operative times.