Abstract
Abdominal myomectomy for a huge myomas, especially uterine cervical myoma, is difficult
because of risks, such as intraoperative bleeding or injury to adjacent organs. Therefore,
understanding of the positional relationships among a huge myoma, especially cervical
or intraligamental myoma, and the vascular plexuses in the right and left cardinal
ligaments is important for prevention of massive bleeding during myomectomy. While
sufficiently performing preoperative assessment with pelvic examination, ultrasonography,
magnetic resonance imaging (MRI), etc., surgeons should always keep in mind how they
can reduce the blood loss volume, while safely and surely performing resections. For
a cervical myoma of the uterus and giant uterine leiomyoma that leave no intrapelvic
space and prevent palpation and identification of the uterine arteries and the internal
iliac arteries, surgery can be performed safely by preoperatively placing balloon
catheters in the internal iliac arteries. Hemostaic strategies for myomectomy and
tips of subsequent pregnancy following myomectomy are also described.
Keywords
abdominal myomectomy - hemorrhage - huge myoma - intra-arterial balloon occlusion
- uterine cervical myoma
