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Foley Catheter Tourniquet in Laparoscopic Myomectomy

Year: 2025
Type: article
Study design: Case Report
Abstract: OBJECTIVE The objective is to describe a technique of applying tourniquet at the uterine isthmus using a Foley catheter to reduce the blood loss during laparoscopic myomectomy. DESIGN A step-by-step laparoscopic technique using a narrated video recording is presented in this article [Video]. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"Video 1.","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_7qb5xi6h"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]} PATIENT The patient was a 29-year-old nulliparous female who has a long history of menorrhagia and had a desire for future fertility. Ultrasound examination showed a Federation of Gynecology and Obstetrics type 3 posterior leiomyoma measuring 100 mm × 92 mm × 80 mm. INTERVENTIONS The tourniquet was prepared using a 14 Fr Foley catheter where the balloon port was cut-flushed to the catheter body. Part of the urine drainage port was also removed The catheter was then stabbed using a no 15 scalpel to create a tract within the tubing where the distal end of the catheter was threaded through to create a loop The laparoscopic entry followed the standard close entry method The posterior leaf of the broad ligament was opened at a point 2 cm superior to the uterosacral ligament and 1 cm lateral to the uterus, using a right-angle forceps The disassembled loop catheter was then brought into the peritoneal cavity through a 12-mm laparoscopic cannula A laparoscopic grasper was introduced into the peritoneal cavity, directly without a laparoscopic cannula, through a small incision just above the symphysis pubis The grasper was then used to puncture the broad ligaments anteriorly, exiting at the posterior openings created earlier The urine drainage port was pulled out through the left (broad ligament) opening while the distal catheter tip was pulled through on the right side The distal catheter tip was then pulled through the tract in the catheter using a grasper, recreating the loop tourniquet at the level of the uterine isthmus [Figure 1] The tourniquet was then tightened, compressing the uterine vessels, with the tension maintained by suturing the loop The myomectomy was then performed as per usual technique and the tourniquet released at the end of the surgery. Figure 1: A grasper is threaded through the holes in the catheter and used to pull the distal end of the catheter to form a loop.http://www.apagemit.com/page/video/show.aspx?num=1391&kind=2&page=1Tourniquet has been widely used to reduce blood loss during open myomectomy but not an established technique in laparoscopic surgery. Techniques of applying a suture at the level of the uterine isthmus in laparoscopic myomectomy had been described.[1-3] The use of suture could, however, pose a risk of laceration of the uterine vascular bundle if the tension applied is excessive and may be difficult to cut and removed. Recently, a tourniquet technique using a Foley catheter had been reported but the method compresses not just the uterine vessels, but also encircles the fallopian tubes, limiting its application mostly to the fundal fibroid.[4] Our modification compresses the uterine vessels at the uterine isthmic area and could be applied in wider variety of leiomyoma. In the above patient, the estimated intraoperative blood loss was 125 mL and the fibroid weighted 205 mg. The characteristics of women that had undergone laparoscopic myomectomy with uterine tourniquet are depicted in Supplementary Table 1. The mean fibroid weight was 227.0 g (±129.5 g), and the mean blood loss was 205.0 mL (range 100–500 mL).This technique, however, may be difficult or unable to be applied in lower segment uterine fibroid and in the presence of adhesion at the lower uterine segment or pouch of Douglas. Yet, it is still one of the easier vascular occlusive techniques in laparoscopic myomectomy. CONCLUSION Applying Foley catheter tourniquet at the level of uterine isthmus is an easy-to-learn technique, yet effective in reducing the blood loss during laparoscopic myomectomy. Ethical statement This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and its amendments. The authors certify that they have obtained all appropriate patient consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Author contributions ZAZ and FMA contributed to the study conception, design and execution, data analysis and management, and drafting of the manuscript. NAZ and NMN participated in video recording, presentation preparation, and editing. All authors read and approved the final manuscript. Data availability statement Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W4415984144
FWCI:
Cites: 4
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