Taylor, Andrew Alexander; (2005) Haemostasis at open and laparoscopic myomectomy with the use of modified triple tourniquets. Doctoral thesis , UCL (University College London).

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Abstract

Objectives: To investigate the prevalence of haemostatic techniques at myomectomy. To investigate the effectiveness of modified triple tourniquets at open myomectomy and for the first time to pilot their use at laparoscopic myomectomy. Design: A questionnaire based postal survey. A randomised controlled trial (RCT) and a feasibility study Population All UK Consultant Obstetricians Gynaecologists. 38 patients with symptomatic fibroids undergoing open or laparoscopic myomectomy. Methods: A standard questionnaire postal survey. At open myomectomy a number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries, and polythene (polyglactin at laparoscopic myomectomy) tourniquets were tied around the ovarian vessels. At the end of the procedure the ovarian ties were released but the uterine artery suture remained in situ. Outcome measures Use of haemostatic techniques at open, laparoscopic and hysteroscopic myomectomy. Intra-operative blood loss, post-operative blood loss, blood transfusion rates, operative morbidity, uterine blood flow, ovarian function, quality of life and effect on menstruation. Results: 59% responded to the survey. At open myomectomy 90% regularly used a haemostatic technique, with 85% prescribing pre-operative gonadotrophin releasing hormone agonists. Open myomectomy RCT there was less blood lost in the tourniquet group than in the control (p 0.0001). The volume in the pelvic drain postoperatively failed to reach statistical significance between the two groups. There were no differences in uterine artery Doppler resistance indices and ovarian function was unaffected by the tourniquets. Open myomectomy significantly improved menorrhagia and quality of life. In the laparoscopic study triple tourniquets were applied successfully and appeared effective. Conclusions: Modified triple tourniquets are effective in reducing bleeding at open myomectomy and appear safe with no obvious effect on uterine perfusion or ovarian function. Our feasibility study would suggest they can also be successfully used at laparoscopic myomectomy.

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