ABSTRACT
Laparoscopic myomectomy has many advantages over laparotomy but may involve significant blood loss. This chapter intends to discuss the options to reduce the blood loss during laparoscopic myomectomy and the effectiveness and evidence supporting their use.
Preoperatively, gonadotropin-releasing hormone agonist or aromatase inhibitors have been associated with loss of the surgical plane. Intraoperative options encompass oxytocin, tranexamic acid, injection of normal saline, or vasopressin into the subcapsular layer of the myoma. Mechanical options include a tourniquet at the level of the uterine artery insertion, ligating/clipping/coagulating the uterine arteries, or temporary clamping of the uterine arteries. Also, the intraoperative principle of surgery is discussed in this chapter.
