RCOG World Congress 2025

BLOODLESS LAPAROSCOPIC MYOMECTOMY IN A PATIENT WITH CHRONIC KIDNEY DISEASE AND SEVERE ANAEMIA NEEDING A RENAL TRANSPLANT

Dr. SagarikaGadh, Dr.DineshKansal, Dr. SaloniArora, Dr. SupriyaMahipal, Dr. Tanya Buckshee Rohatgi, Dr.NamrataSingh

INTRODUCTION

Uterine fibroids are benign growth in the uterus that can cause pain and heavy bleeding. Laparoscopic myomectomy is a minimally invasive option for fibroid removal, offering reduced postoperative pain, quicker recovery, and less intraoperative blood loss In selected cases, additional techniques such as pre-myomectomy uterine artery ligation can further reduce bleeding, which is especially beneficial in patients where transfusion should be avoided.

CASE STUDY

•A 32-year-old woman with CKD undergoing dialysis resented large sub-serosal fibroid measuring 12 x 15 cm which was hampering the surgical field for kidney transplant.

•Preoperative blood work up-

1. Hb-8.8g/dl -managed with erythropoietin and ferric carboxymaltoseas advised by the nephrologist.

2. Serum creatinine- 7.35 mg/dl and urea- 87.0 mg/dl- dialyzed a day before surgery to optimize the renal status.

•Intraoperative –

1.Bilateral reversible uterine artery ligation was done at origin, following retroperitoneal dissection, isolating the artery from the internal iliac branch near the ureter, using posterolateral approach and temporarily sutured with vicryl No 1 in shoelace pattern.

2.Following which laparoscopic myomectomy with in bag morcellation for the large myoma was done, clearing the surgical field for the transplant. The suture was removed post-procedure to restore blood flow. She underwent a successful renal transplant on 17.02.25 and is recovering well.

DISCUSSION

•Reversible bilateral uterine artery ligation during myomectomy reduces intraoperative blood loss and preserves fertility.

•Studies show improved surgical outcomes, fewer complications, and maintained uterine function.

•Studies by Carranco et al, supports its efficacy making it a valuable adjunct during conservative uterine preservation surgery for large myomas.

SUMMARY

In a CKD patient with hypertension and anaemia, bloodless laparoscopic myomectomy was achieved through multidisciplinary planning, precise dissection, and bilateral reversible uterine artery ligation. Avoiding vasopressin and hypotensive anaesthesia, this approach ensured stable haemodynamics, effective haemostasis and a safe transfusion free outcome.

Ref : Ramiro Cabrera Carranco 1, Andres Vigeras 2, Reitan Ribeiro 3, Monica Tessmann Zomer 4, William Kondo 4.

Locatelli F, Bárány P, Covic A, et al. Kidney Disease: Improving Global Outcomes guidelines on anaemia management in chronic kidney disease. Nephrol Dial Transplant.

RCOG World Congress 2025

Bloodless Laproscopic Myomectomy of CKD patient with Severe anaemia needing renal transplant.

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