THE EFFECT OF OPERATIVE TECHNIQUE AND UTERINE SIZE ON BLOOD-LOSS DURING MYOMECTOMY - A PROSPECTIVE RANDOMIZED STUDY

Objectives: To compare operative blood loss between two accepted blood loss-reducing techniques used during myomectomy and to evaluate the e ffect of preoperatively determined uterine volume on blood loss. Desig n: Subjects were stratified by ultrasound-determined uterine volume <6 00 cm(3) (n = 11) and greater than or equal to 600 cm(3) (n = 10) and then randomized into treatment groups. The same radiologist, surgeons, and anesthetic induction technique were involved in every case. In th e pharmacologic technique, diluted vasopressin (20 U in 20 mL normal s aline) was injected into the serosa and/or myometrium overlying the fi broid(s) before the uterine incision(s). In the mechanical technique, a penrose drain tourniquet was passed through defects created in the b road ligaments at the level of the internal os and secured posteriorly , occluding the uterine vessels. In addition, vascular clamps were pla ced on the infundibulopelvic ligaments, occluding anastomotic blood fl ow through the ovarian vessels. Results: There was no difference in op erative blood loss, operating time, preoperative and intraoperative me an arterial blood pressures, postoperative febrile morbidity, preopera tive and postoperative hematocrits, transfusion rates, and length of h ospital stay between groups. Blood loss was significantly greater for uteri with ultrasound-determined volumes greater than or equal to 600 cm(3) (627 +/- 175 mL, mean +/- SEM) than for those <600 cm(3) (228 +/ - 49 mL). For all subjects, blood lost while operating on the uterus ( mean, 379 mL; range, 35 to 1,968 mL) was positively correlated with th e total weight of the fibroids resected and with time spent operating on the uterus. Total blood loss (mean, 418 mL; range, 42 to 1,968 mL) was also positively correlated with the time spent operating on the ut erus and with total operating time. Conclusions: There were no demonst rable differences in blood loss, morbidity, or transfusion requirement s between subjects undergoing myomectomy using pharmacologic vasoconst riction and mechanical vascular occlusion techniques. Blood loss durin g myomectomy is primarily incurred while operating on the uterus and i s correlated with preoperative uterine size, total weight of fibroids removed, and operating time.