Preventive Uterine Artery Occlusion: Benefits of the Laparoscopic Posterior Approach

Journal of Minimally Invasive Gynecology
Jean DubuissonPatrick Petignat

Abstract

To present a standardized and minimally invasive procedure to occlude uterine artery via a posterior approach. Step-by-step explanations of the technique using videos (Canadian Task Force classification III). The preventive occlusion of uterine arteries during uterine surgery reduces perioperative bleeding by temporarily devascularizing the uterus. This technique, usually performed by conventional or robotically assisted laparoscopy, can be combined with surgical procedures that have a potential risk of major bleeding such as myomectomy or hysterectomy, particularly in cases of a large uterus. Here, we describe a minimally invasive technique using a laparoscopic posterior approach of the retroperitoneal space, which allows more direct access to the uterine pedicles. Institutional review board approval was obtained through our local ethics committee in Geneva University Hospitals. The main occlusion technique described in the literature involves a superior approach at the level of the lateral pelvic triangle. We propose to access the uterine artery via a posterior approach at the posterior and inferior level of the broad ligament. The peritoneum is opened after previous identification of the uterine artery and the ureter by tran...Continue Reading

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