The Use of Vasopressor and Tourniquet to Reduce Hemorrhage during Myomectomy for Uterine Fibroid Removal: A Systematic Review

Suskhan Djusad; Ario Bimo; Annisa Futihandayani

doi:10.3889/oamjms.2024.11786

Authors

Suskhan Djusad Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, 10430, Jakarta, Indonesia https://orcid.org/0000-0001-9818-7456
Ario Bimo Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, 10430, Jakarta, Indonesia https://orcid.org/0000-0002-2553-3079
Annisa Futihandayani Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, 10430, Jakarta, Indonesia https://orcid.org/0009-0003-2230-3897

DOI:

https://doi.org/10.3889/oamjms.2024.11786

Keywords:

vasopressin, tourniquet, myomectomy, uterine fibroid

Abstract

AIM: This review aims to evaluate the efficacy of vasopressin and tourniquet to reduce blood loss during myomectomy for uterine fibroids removal.

BACKGROUND: Uterine fibroids and uterine leiomyomata, the most common benign tumors in women, can be difficult for women trying to conceive. Surgical therapy, such as hysterectomy or myomectomy, is one of the main treatment options. Excessive blood loss may occur during the procedure. Clamps or tourniquets around the uterine vessels are commonly used as anti-bleeding precautions during myomectomy. Intra-myometrial injection of vasopressin at the base of the largest fibroids and during hysteroscopic myomectomy is effective in reducing blood loss during laparoscopic myomectomy.

METHODS: A literature search and computer-aided comprehensive electronic bibliographic search was performed using PubMed, Science Direct, SCOPUS, and Wiley for studies published from January 1997 to November 2017.

RESULTS: Ten studies met the eligibility criteria and were included in this review. Each study assessed and compared the effects of vasopressin to the control group that exerts a hormonal hemorrhagic effect during myomectomy procedures. About 50% of vasopressin hemostatic agents have better outcomes in reducing blood loss. However, the use of both vasopressin and tourniquet simultaneously failed to reduce blood loss.

DISCUSSION: Intramyometrial vasopressin injection resulted in a higher efficacy to decrease blood loss during myomectomy. Despite deciding which methods provide the most effective way to decrease blood loss, the two techniques showed excellent outcomes for the quality of the myomectomy procedure itself.

CONCLUSION : Hemostatic medications have shown to have positive effects on myomectomy patients. The predicted volume of blood loss significantly decreased by both the mechanical tourniquet approach and the injection of the hormone vasopressin.

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References

Barjon K, Mikhail LN. Uterine leiomyomata (fibroids). In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546680 [Last accessed on 2020 Oct 16].

Williams AR. Uterine fibroids – what’s new? F1000Res. 2017;6:2109. https://doi.org/10.12688/f1000research.12172.1 PMid:29259779

Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and management of complications in laparoscopic myomectomy. Biomed Res Int. 2018;2018:8250952. https://doi.org/10.1155/2018/8250952 PMid:29693017

Fletcher H, Frederick J, Hardie M, Simeon D. A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol. 1996;87(6):1014-8. https://doi.org/10.1016/0029-7844(96)00071-3 PMid:8649682

Frederick J, Fletcher H, Simeon D, Mullings A, Hardie M. Intramyometrial vasopressin as a haemostatic agent during myomectomy. Br Int J Obstet Gynaecol. 1994;101(5):435-7. https://doi.org/10.1111/j.1471-0528.1994.tb11918.x PMID: 8018617

Saha MM, Khushboo, Biswas SC, Alam H, Kamilya GS, Mukhopadhyay M, et al. Assessment of blood loss in abdominal myomectomy by intramyometrial vasopressin administration versus conventional tourniquet application. J Clin Diagn Res. 2016;10(5):QC10-3. https://doi.org/10.7860/JCDR/2016/17484.7789 PMid:27437308

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ 2009;339:b2535. https://doi.org/10.1136/bmj.b2535 PMid:19622551

Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, et al. Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Oxford: Centre for Evidence-Based Medicine (CEBM); 1998. Available from: https://www.cebm. ox.ac.uk/resources/levels-of-evidence/oxford-centre-for- evidence-based-medicine-levels-of-evidence-march-2009 [Last accessed on 2020 Oct 17].

Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ. The effect of operative technique and uterine size on blood loss during myomectomy: A prospective randomized study. Fertil Steril. 1993;60(6):956-62. https://doi.org/10.1016/s0015-0282(16)56392-4 PMid:8243699

Protopapas A, Giannoulis G, Chatzipapas I, Athanasiou S, Grigoriadis T, Kathopoulis N, et al. Vasopressin during laparoscopic myomectomy: Does it really extend its limits? J Minim Invasive Gynecol. 2018;26(3):441-9. https://doi.org/10.1016/j.jmig.2018.05.011 PMid:29778690

Sapmaz E, Çelik H. Comparison of the effects of the ligation of ascending branches of bilateral arteria uterina with tourniquet method on the intra-operative and post-operative hemorrhage in abdominal myomectomy cases. Eur J Obstet Gynecol Reprod Biol. 2003;111(1):74-7. https://doi.org/10.1016/s0301-2115(03)00207-0 PMid:14557016

Dillon TF. Vasopressin as a hemostatic in gynecologic surgery. Am J Obstet Gynecol. 1959;78(6):1285-91. https://doi.org/10.1016/0002-9378(59)90591-5 PMid:13816786

Cohen SL, Senapati S, Gargiulo AR, Srouji SS, Tu FF, Solnik J, et al. Dilute versus concentrated vasopressin administration during laparoscopic myomectomy: A randomised controlled trial. BJOG. 2016;124(2):262-8. https://doi.org/10.1111/1471-0528.14179 PMid:27362908

Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A. Reducing blood loss at open myomectomy using triple tourniquets: A randomised controlled trial. BJOG. 2005;112(3):340-5. https://doi. org/10.1111/j.1471-0528.2004.00430.x PMid:15713151

Kathiresan AS, Brookfield KF, Gonzalez-Quintero VH, Verma U. Vasopressin versusacombination of vasopressin and tourniquets: A comparison of blood loss in patients undergoing abdominal myomectomies. Aust N Z J Obstet Gynaecol. 2010;51(1):79-83. https://doi.org/10.1111/j.1479-828x.2010.01253.x PMid:21299514

Agida ET, Isah AD, Isah AY. Intramyometrial vasopressin for reducing blood loss at myomectomy. Ann Med Health Sci Res. 2020;10:857-64.

Chilkoti G, Mohta M, Nath S, Saxena AK, Khurana P. Anaesthetic concerns with intramyometrial vasopressin during myomectomy. Ain-Shams J Anaesthesiol. 2016;9:452-4. https://doi.org/10.4103/1687-7934.189089

Sanyal U, Ghosh S, Hiremath PB, Hiremath R The role of tourniquet in myomectomy: An observational study. Int J Reprod Contracept Obstet Gynecol. 2019;8(4):1610-5. https://doi.org/10.18203/2320-1770.ijrcog20191227

Kongnyuy EJ, van den Broek N, Wiysonge CS. A systematic review of randomized controlled trials to reduce hemorrhage during myomectomy for uterine fibroids. Int J Gynecol Obstet. 2007:100(1);4-9. https://doi.org/10.1016/j.ijgo.2007.05.050 PMid:17894936

Ikechebelu JI, Eczema CO, Obiechina NJ. The use of tourniquet to reduce blood loss at myomectomy. Niger J Clin Pract. 2010;13(2):154-8. PMid:20499747