Laparoscopic Uterine Artery Ligation Studied. (Fibroids Treated in 33 Patients).

OR ORLANDO, FLA. -- Laparoscopic uterine artery ligation may be the gynecologic surgeon's best answer to uterine artery embolization performed by interventional radiologists, Dr. Leroy Charles said at a meeting of the One Kilo Club.

The delicate procedure performed through four surgical ports has produced good results in 33 of Dr. Charles' patients, including 1 woman with multiple leiomyomas who avoided a hysterectomy and was able to become pregnant.

Not all patients with uterine leiomyomas are candidates for uterine artery embolization (UAE) or laparoscopic uterine ligation. Some fibroids require hysterectomy, said Dr. Charles of Tufts University in Boston.

But for the many patients with fibroids and menometrorrhagia, a simpler alternative is in great demand. Laparoscopic surgery could meet that patient desire, perhaps with fewer drawbacks than the UAE procedure, in which particles or Gelfoam are inserted via a catheter threaded from the groin through the femoral artery to the uterine artery.

"Transcatheter arterial embolization is successful and safe most of the time," Dr. Charles said. But serious complications, including necrosis, peritonitis, and one death from septicemia, have been reported.

Uterine artery embolization is also expensive, reportedly reimbursed by some insurance companies at up to S 17,000. The cost of a laparoscopic hysterectomy by contrast, is reimbursed at about $600-$1,800, Dr. Charles said at the meeting held in conjunction with the 37th International College of Surgeons' North American Federation Congress.

Dr. Charles' technique for uterine artery ligation was perfected by practicing on cadavers, he explained at the first meeting of the One Kilo Club, the ob.gyn. section of the U.S. Section of the International College of Surgeons.