Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

• Published in: Gynecologic and obstetric investigation Vol. 85; no. 5; p. 396
• Main Authors: Mehdizadehkashi, Abolfazl, Tahermanesh, Kobra, Rokhgireh, Samaneh, Astaraei, Vahideh, Najmi, Zahra, Rakhshande, Mehrnoosh, Allahqoli, Leila, Ahmadi Pishkuhi, Mahin, Alkatout, Ibrahim, Chaichian, Shahla
• Format: Journal Article
• Language: English
• Published: Switzerland 01.12.2020
• Subjects: Adult; Anti-Mullerian Hormone - blood; Blood Loss, Surgical; Double-Blind Method; Female; Follicle Stimulating Hormone - blood; Hemoglobins - metabolism; Humans; Leiomyoma - surgery; Operative Time; Ovarian Reserve; Postoperative Period; Preoperative Period; Tourniquets; Uterine Myomectomy - methods; Uterine Neoplasms - surgery; Tourniquets; Hemorrhage; Ovarian reserve; Uterine myomectomy
• ISSN: 1423-002X
• DOI: 10.1159/000510512

A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (n = 46) or a non-tourniquet group (n = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. Demographic, obstetric, and myoma characteristics were similar in the 2 groups (p > 0.05). The mean baseline values of AMH and FSH did not differ between groups (p > 0.05). After surgery, only FSH was higher in the control group (p = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (p < 0.001). Blood loss was higher in the control group (p = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (p = 0.002). Blood loss was significantly associated with the duration of surgery (r = 0.523, p < 0.001). The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.