Laparoscopic   Uterine   Artery   Coagulation   (LUAC)  for Treatment of Abnormal Uterine Bleeding Refractory to Medical Treatment 

Ammar Rafiq,  Corah Ohadike, Raphael Laiyemo

 

Objective

To present laparoscopic uterine artery coagulation (LUAC), a novel uterine sparing technique, for managing irregular, heavy vaginal bleeding unresponsive to medical therapy.

 

Background

A 33-year-old woman (G5P2) with a history of heavy, irregular vaginal bleeding unresponsive to medical therapy. Despite multiple treatments, including oral medroxyprogesterone, tranexamic acid (TXA), and GnRH analogues, her symptoms persisted. Extensive investigations, including hysteroscopy, endometrial biopsy, CT angiogram, and 3D ultrasound, revealed no abnormalities.

Given her strong desire to preserve the uterus and the absence of embolizable large vessels, uterine artery embolization (UAE) was deemed unsuitable. After a multidisciplinary team (MDT) discussion, she was offered LUAC as an alternative treatment.

 

Procedure

• Laparoscopic access was achieved, and the posterior leaf of the broad ligament was dissected to the uterine isthmus.
• The uterovesical fold was opened, and the bladder was carefully reflected downward.
• Peritoneal windows were created bilaterally, and the uterine arteries were skeletonized.
• The ascending branches of the uterine arteries were coagulated bilaterally using harmonic energy.
• The uterovesical fold was closed with 2-0 Vicryl sutures.