Clinical application of reversible uterine artery occlusion with vascular clips during minimally invasive myomectomy

LI Ke; MENG Xiao; SONG Siyu; HAN Shichao

doi:10.3969/j.issn.2095-8331.2025.03.009

Abstract：Objectives To evaluate the clinical value and learning curve of using vascular clips for reversible uterine artery occlusion during minimally invasive myomectomy.Methods A retrospective analysis was conducted on 92 patients with uterine fibroids who underwent treatment at the Obstetrics and Gynecology Department of the Second Affiliated Hospital of Dalian Medical University between January 2021 and July 2023.The patients were divided into observation group and control group based on the use of vascular clips during surgery.Both groups were further divided into laparoscopic and robot-assisted laparoscopic subgroups according to the surgical approach.The advantages of the two groups were analyzed pre-and post-operation.The cumulative sum(CUSUM)method was applied to assess the learning curve for vascular clip application during uterine artery occlusion.A fitting curve was plotted using the CUSUM data,with the R2 value used to determine the goodness of fit.Based on the curve's inflection point,the learning phase and proficiency phase were identified.Results The observation group had obvious advantages over the control group in bowel function recovery times,and hemoglobin and hematocrit levels(P<0.05).None of the 92 patients experienced endometrial injury or other complications,and no intra-or post-operative blood transfusions were required in either group.During the 1-year follow-up,no long-term complications were reported in the observation group.CUSUM analysis indicated that the optimal fitting curve for the laparoscopic group was Yˆ=0.148 X3-7.586 X2+88.957 X+220.827(X=case number,R2=0.949,P<0.01).Proficiency in the laparoscopic technique was achieved after approximately 8 cases.In the robot-assisted group,the optimal fitting curve was Yˆ=0.209 X3-9.120 X2+90.250 X+229.716(X=case number,R2=0.954,P<0.01),with proficiency achieved after approximately 6 cases.Conclusions In minimally invasive myomectomy,the use of vascular clips for reversible uterine artery occlusion requires approximately 6-8 cases to achieve proficiency.This technique effectively reduces intraoperative bleeding,maintains a clear surgical field,and facilitates postoperative recovery.Additionally,it aids in identifying and preserving the endometrium when removing large fibroids that compress it.The method is safe,effective,and feasible.