Improving Safety and Feasibility of Abdominal Myomectomy in Low-Resource Settings Using Uterine and Infundibulopelvic Ligament Tourniquet: A Systematic Review.

Aim: To evaluate the efficacy and safety of using a uterine and infundibulopelvic ligament tourniquet during abdominal myomectomy to reduce intraoperative bleeding in low-resource settings. Methods: PubMed and Cochrane Library database searching up to March 2023. The PICOS standards were as follows: (Population) patients undergoing abdominal myomectomy surgery for uterine fibroids; (Intervention) the use of a uterine and ligament tourniquet during abdominal myomectomy; (Comparators) use of a uterine and infundibulopelvic ligament tourniquet to no intervention or alternative interventions for reducing intraoperative bleeding; and (Outcomes) reduction in intraoperative bleeding, in addition to the relative ease of use of the uterine and infundibulopelvic ligament tourniquet and any reported complications or adverse events of the intervention. Results: Thirteen studies, consisting of seven randomized controlled trials and six observational studies, were included in this review. All studies reported a significant reduction in intraoperative bleeding when using the uterine and infundibulopelvic ligament during abdominal myomectomy, ranging from 30% to 60%. The tourniquet was found to be particularly effective in cases with large or lower segment fibroids, and it was easy to use, even in low-resource settings. Conclusion: The use of a uterine and infundibulopelvic ligament tourniquet during abdominal myomectomy appears to be a safe and effective method of reducing intraoperative bleeding. [ABSTRACT FROM AUTHOR]