Evidence-Based Practice for Minimization of Blood Loss During Laparoscopic Myomectomy: An AAGL Practice Guideline

Abstract

Study Objective

To provide evidence-based recommendations regarding the use of pre-operative medical adjuncts and intra-operative interventions for reducing blood loss during laparoscopic (conventional or robotic-assisted) myomectomy.

Design

A systematic review and meta-analyses of the relevant literature were performed to develop evidence-based guideline recommendations.

Setting

Published literature.

Patients

Patients undergoing laparoscopic myomectomy.

Interventions

Pre-operative medical adjuncts and intra-operative interventions for reducing blood loss.

Measurements and Main Results

The primary outcome was surgical blood loss. Secondary outcomes were change in hematocrit or hemoglobin and blood transfusion. Additional outcomes included length of procedure, intra- and post-operative complications, conversion to laparotomy, reoperation, readmission, and length of stay. A total of 75 studies fulfilled the eligibility criteria and formed the basis for this practice guideline. Evidence-based recommendations were developed regarding the use of pre-operative medical adjuncts including gonadotropin-releasing hormone agonist and progesterone), as well as intra-operative vasoconstrictors, uterine artery occlusion, electrosurgical devices and barbed suture.

Conclusions

Systematic review and multiple meta-analyses identified moderate evidence supporting the use of 3-month administration of leuprolide acetate prior to myomectomy and intra-operative use of misoprostol, epinephrine, vasopressin, oxytocin, and uterine artery occlusion for reducing blood loss during laparoscopic myomectomy.