Objective: Devascularization of the uterus is essential in performing laparoscopic myomectomy. The commonest technique to devascularize the uterus is by injecting Vasopressin into the uterus and fibroids. However, in some countries vasopressin in banned. In some patients vasopressin is contraindicated. In these patients devascularisation of the uterus can be difficult. In open surgery, a Foley’s catheter is used as a tourniquet to reduce bleeding (1). In this video I will show how a Foley’s catheter can be used to temporarily devascularize the uterus during laparoscopic myomectomy.
Design: Presentation of the technique of applying a tourniquet using a Foley’s catheter in a case of laparoscopic myomectomy
Setting: Mahkota Medical Centre, Melaka, Malaysia
Intervention: A 27-year-old lady underwent a spontaneous miscarriage at 18 weeks of pregnancy. She had a large fundal fibroid measuring 5.25 x 5.26 cm and another small subserous fibroid. She underwent a laparoscopic myomectomy. Due to irregular heart rate, the anesthetist declines the usage of vasopressin to devascularize the uterus during the laparoscopic myomectomy. A Foley’s catheter was used to temporarily devascularize the uterus during laparoscopic myomectomy. Her blood loss during the surgery was only 100mls. Postoperatively the patient is well.
A Foley’s catheter can be used in as a tourniquet to temporarily occlude the ascending branch of the uterine artery during laparoscopic myomectomy. Its application can be challenging especially when the fibroids are low such as cervical fibroids. In prolonged laparoscopic myomectomies, when the effect of vasopressin is wearing off this tourniquet can be applied to control bleeding while laparoscopic suturing is performed. The use of Foley’s catheter in this indication is an off-label use in most countries.
Sources / references
1. Urmi Sanyal, Shilpa Ghosh, Hiremath P. B, Reshma Hiremath. The role of tourniquet in myomectomy: an observational study. Int J Reprod Contracept Obstet Gynecol. 2019 Apr;8(4):1610-1615 www.ijrcog.org