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Changes in uterine blood flow following laparoscopic myomectomy with or without uterine artery ligation on two‐ and three‐dimensional power Doppler ultrasound
Author(s) -
Chang W.C.,
Huang S.C.,
Sheu B.C.,
Shih J.C.,
Hsu W.C.,
Chen S. Y.,
Chang D.Y.
Publication year - 2009
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.6225
Subject(s) - medicine , uterine artery , blood flow , ultrasound , perfusion , uterus , ligation , surgery , laparoscopic surgery , uterine leiomyoma , artery , uterine myomectomy , leiomyoma , laparoscopy , radiology , myoma , pregnancy , genetics , gestation , biology
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.