Chemically assisted dissection of tissues: An interesting support in abdominal myomectomy

Background: The aim of this study was to verify the efficacy of sodium-2-me rcaptoethanesulfonate (mesna) in the chemical separation of tissues in abdo minal myomectomies when used with the traditional mechanical separation tec hniques. Study Design: In a prospective, randomized study, 58 women under-went abdom inal myomectomy. In 29 of these, we used mesna for highlighting and separat ing tissues, and in the other 29 we used saline solution for the same purpo ses. The variables evaluated included the number of myomas removed, the vol ume of the biggest myoma, and the total volume of the myomas removed in eve ry intervention. We also recorded operating time, the length of hospital st ay, the degree of procedure difficulty perioperative blood loss, operative complications, and cost. Results: The operation was significantly shorter in the mesna group (p < 0. 05) even though the volume and the number of myomas were larger. The degree of difficulty evaluated by the surgeon at the end of every operation was n ot significantly different in the two groups. The reduction in hemoglobin 2 4 hours after operation was significantly less in the patients treated with mesna (p = 0.006), but this difference was probably altered by the increas e in hematocrit levels. Conclusions: Because of its ability as a chemical dissector, mesna may be a useful aid in this type of benign gynecologic operation. Larger studies to confirm this are needed. (J Am Cell Surg 2000;191:65-69. (C) 2000 by the A merican College of Surgeons).