Uterine artery blockage via the anterior cul-de-sac in minimally invasive myomectomy: Experience of 61 cases

Salma Moustafa, Moustafa S, Lucia Di Francesco, Di Francesco L, Uzianbaeva L, Liaisan Uzianbaeva, Mikhail M, Magdy Mikhail, Wang P
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026 · vol. 174(2) , pp. 844–851 · doi:10.1002/ijgo.70913 · PMID:41721456 · PMC13377364
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A retrospective case series of 61 patients demonstrated that uterine artery blockage via the anterior cul-de-sac during minimally invasive myomectomy requires approximately 34 cases for proficiency and facilitates safe performance with low blood loss.

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Abstract

OBJECTIVE: To evaluate the learning curve of uterine artery blockage via the anterior cul-de-sac and demonstrate the favorable outcomes of its application into complex minimally invasive myomectomy (MIM). METHODS: A retrospective case series conducted at a teaching hospital and tertiary referral center, including 86 consecutive patients who underwent MIM by a single surgeon between September 2022 and August 2025. Uterine artery blockage via the anterior cul-de-sac was attempted in 61 cases, while 25 cases of MIM were performed without attempt. RESULTS: Of the 61 attempted cases, bilateral blockage was successful in 49 cases, unilateral in seven, and none in four. Consistent bilateral success was achieved after 34 cases. Most patients had more than five fibroids (39/61), with a median largest fibroid size of 8.1 cm (interquartile range [IQR]: 6.2-12.0 cm), and specimen weight of 430 g (IQR: 205.5-772.5 g). The median estimated uterine size was 16.0 weeks (IQR: 15-20 weeks). The median operative time was 246 min (IQR: 209-281 min), and the median estimated blood loss (EBL) was 250 mL (IQR: 100-350 mL). Preoperative hemoglobin averaged 11.8 ± 1.8 mg/dL, with a mean drop of 2.1 ± 1.4 mg/dL. Surgical approaches included laparoscopy (17), laparoscopic-assisted myomectomy (LAM) (26), and mini-laparotomy (18). One intraoperative vascular complication and one intraoperative transfusion occurred. The median hospital stay was 1 day (IQR: 1.0-2.0). There was eight postoperative transfusions, and two Clavien-Dindo class I complications with no readmissions. CONCLUSION: Approximately 34 cases are required for a surgeon to achieve proficiency, and incorporation of this technique facilitates the safe and feasible performance of complex MIM.

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MeSH descriptors

Leiomyoma Leiomyoma Minimally Invasive Surgical Procedures Minimally Invasive Surgical Procedures Uterine Artery Uterine Artery Uterine Artery Embolization Uterine Artery Embolization Uterine Myomectomy Uterine Myomectomy Uterine Neoplasms Uterine Neoplasms Adult Blood Loss, Surgical Female Humans Learning Curve Middle Aged Operative Time Retrospective Studies

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