- Pisat S.: Department of Gynecology, Akanksha Hospital, Mumbai, India.
van Herendael B.: Department of Gynecological Endoscopy, ZNA Stuivenberg Hospital, Antwerp, Belgium.
INTRODUCTION: The use of vasopressin and other vasoconstrictive agents to reduce blood loss during laparoscopic myomectomy significantly reduces blood loss and operative time. However, serious cardiovascular complications following the use of intramyometrial injection of vasopressin solution have also been reported. Most of these side effects are believed to be due to inadvertent intravascular injection of vasopressin solution.
AIMS AND OBJECTIVES: To describe a new design of an injection needle. Pisat’s visual vasopressor injection needle (VVIN) can be used during laparoscopic myomectomy to minimise the incidence of an inadvertent intravascular injection of a vasoconstrictor solution.
RESULTS: A total of 53 patients who underwent laparoscopic myomectomy at various hospitals in Mumbai, India were studied over a period of two years. Out of these, 23 patients were operated upon using a standard 5 mm laparoscopic injection needle, and 30 patients were operated on by using a VVIN. Out of the 23 patients in whom a regular needle was used, four patients (17.39%) demonstrated a significant (over 20% of pre-injection value), but transient, elevation in pulse and blood pressure readings at one minute post injection. This gradually returned to baseline at 10 minutes after the injection. None of the 30 patients in whom VVIN was used after confirming a negative aspiration demonstrated any significant change in post-injection pulse or blood pressure recordings.
CONCLUSIONS: Using a VVIN during a laparoscopic myomectomy enables the surgeon to detect an inadvertent vascular puncture very early, even in a small calibre blood vessel, and with much more sensitivity than a regular needle. This increases patient safety during the intramyometrial injection of a vasoconstrictive agent during myomectomy and reduces the incidence of catastrophic complications.