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Abstract
Conservative surgery remains the main approach for management of uterine leiomyomas. As more women delay child bearing; myomectomy is becoming an increasingly common surgical treatment for those with symptomatic leiomyomas who wish to preserve their reproductive organs.
Myomectomy through laparotomy is still the approach used in many centers worldwide, however bleeding is often a problem in this operation and can result in: intraoperative hypovolemic shock, postoperative anemia, pelvic infection, and adhesions with infertility.
Many interventions have been performed to reduce bleeding during myomectomy:
Three categories of interventions can be identified
1. Interventions on uterine arteries such as laparoscopic uterine artery dissection, uterine artery embolisation, pericervical mechanical tourniquet and hormonal tourniquets such as vasopressin and terlipressin;
2. Uterotonics such as ergometrine, oxytocin, misoprostol, and sulprostone.
3. Myoma dissection techniques which include the use of laser and chemical dissectors such as sodium-2-mercaptoethane sulfonate (mesna).