To determine the optimal surgical approach for laparoscopic uterine artery ligation (LUAL) combined with myomectomy in the management of women with symptomatic uterine fibroids. This is a prospective study. One hundred and six women with symptomatic uterine myomas underwent LUAL + laparoscopic morcellation after enucleation (enucleation group) (n = 51) or LUAL + laparoscopic in situ morcellation (ISM group) (n = 55). The outcome was measured by comparing surgical techniques, symptom control, recurrence and pregnancy during a 3-year follow-up in both groups. General characteristics of the patients were similar in both groups, except the myomas were larger in the ISM group. The operative time (mean ± SD) was significantly shorter in the ISM group than the enucleation group (107 ± 30 min versus 128 ± 49 min, P = 0.009). There were no differences in the therapeutic outcomes of the two groups at the 3-year follow-up, with low recurrence rates and good symptom control rates. Of the sexually active patients without contraception, the pregnancy and live birth rates were 87.5 and 100% in the ISM group and 66.7 and 83.3% in the enucleation group (all NS). The LUAL + myomectomy, either by enucleation or ISM, is acceptable in the management of symptomatic uterine fibroids. However, the LUAL + ISM technique might be more feasible, as it requires less operative time.

Objective: To evaluate differences in uterine perfusion following laparoscopic myomectomy with or without uterine artery ligation (UAL).Methods: From November 2005 to July 2007, we enrolled prospectively 105 women with symptomatic myomas who were scheduled to undergo laparoscopic myomectomy (57 with UAL (study group) and 48 without (control group)). Power Doppler ultrasound was used to evaluate uterine artery resistance (RI) and pulsatility (PI) indices and peak systolic velocity (PSV) and three‐dimensional (3D) power Doppler ultrasound was used to obtain vascularization (VI), flow (FI) and vascularization flow (VFI) indices of the uterine tissue, which were calculated by VOCAL (Virtual Organ Computer‐aided AnaLysis) software.Results: Characteristics of the myomas, operative time and duration of hospital stay were comparable between the two groups, whereas the median (range) of estimated blood loss (50 (50–200) vs. 100 (50–900) mL, P = 0.001) and the frequency of excessive bleeding of > 500 mL (0% vs. 10%, P = 0.018) were significantly lower in the study group. The RI, PI and PSV were comparable between the two groups preoperatively, significantly lower in the study group 1 week after surgery (0.69 vs. 0.74, 1.31 vs. 1.76, and 34.08 vs. 47.49, respectively, P < 0.05), and comparable again 3 months later. The myometrial VI and VFI decreased after surgery and all three 3D power Doppler indices of the study group were similar to those of the control group throughout the study period.Conclusion: Concurrent UAL during laparoscopic myom‐ ectomy reduces the intraoperative blood loss and frequency of excessive bleeding without permanently compromising uterine perfusion. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.

Background. To study if there are specific problems in laparoscopically assisted vaginal hysterectomy (LAVH) for a certain weight of bulky uteri and the strategies to overcome such problems. Methods. One hundred and eighty‐one women with myoma or adenomyosis, weighing 350‐1,590 g, underwent LAVH between August 2002 and December 2005. Key surgical strategies were special sites for trocar insertion, uterine artery or adnexal collateral pre‐ligation, laparoscopic and transvaginal volume reduction technique. The basic clinical and operative parameters were recorded for analysis. Results. Based on significant differences in the operative time and estimated blood loss, the patients were divided into medium uteri weighing 350–749 g, n = 138 (76%), and large uteri weighing ≥750 g, n = 43 (24%). There was no significant difference in terms of age, body mass index, preoperative diagnoses, complications and duration of hospital stay among groups. The operative time and estimated blood loss increased with larger uterine size (p<0.001). The operative time (196±53, 115–395 min), estimated blood loss (234±200, 50–1,000 ml) and frequency of excessive bleeding (14%) or transfusion (5%) were significantly greater, but in acceptable ranges, for those with large uteri. Conversion to laparotomy was required in a patient (2%) with a large uterus, and the overall conversion rate was 0.6%. There was no re‐operation or surgical mortality. Conclusion. Using various combinations of special strategies, most experienced gynecologic surgeons can conduct LAVH for most large uteri with minimal rates of complications and conversion to laparotomy.