Does Preventive Uterine Artery Occlusion During Laparoscopic Myomectomy Impact on Ovarian Reserve Markers?

NCT ID: NCT02563392

Last Updated: 2024-08-13

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 58 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2015-04-30
• Study Completion Date: 2024-05-31

Brief Summary

Hysterectomy is an effective treatment used as a first-line approach for uterine myomas. Several others alternatives to hysterectomy have been developed in recent years for women wishing to retain their uterus: myomectomy, radiological embolization, focused ultrasound.

Myomectomy, particularly through minimally invasive surgery, is currently considered the conservative treatment of choice for patients wishing to preserve their fertility. However, three important issues should be considered: the risk of intra- and postoperative bleeding, the risk for recurring myomas, and the preservation of subsequent fertility.

Preventive uterine artery occlusion can be combined with laparoscopic myomectomy in order to avoid bleeding and improve uterine suture. Another expected long-term benefit is the improvement of treatment efficacy, leading to less symptoms and myomas recurrence. However, the effect of uterine arteries occlusion on the ovarian reserve of women of childbearing age has not yet been studied, which limits its clinical application.

Detailed Description

Objectives:

1. To assess the effect of preventive uterine artery occlusion during laparoscopic myomectomy on ovarian reserve parameters;

2. To evaluate the effect of preventive uterine artery occlusion during laparoscopic myomectomy on intra- and postoperative blood loss, operative time, clinical symptoms improvement, long-term recurrence of myomas and fertility.

Materials and methods:

Design: This is a prospective randomized single blind trial, including 60 women undergoing a laparoscopic myomectomy for symptomatic uterine myomas. Patients are randomized into two groups: a control group "myomectomy alone" and an experimental group "myomectomy with preventive uterine arteries occlusion".

Setting: The duration of the study will normally be 5 years and will take place at the University Hospitals of Geneva. The study will include about 20 women per year and follow-up will last 2 years. Inclusion criteria are: women of childbearing age, wishing to retain their uterus, having symptomatic uterine myomas and who are eligible for a laparoscopic myomectomy.

The parameters that will be intraoperatively evaluated are the operation time, blood loss and the complications of the surgical technique. Postoperative complications, improving clinical symptoms, myomas recurrence and fertility are discussed at short and long term follow-up.

The ovarian reserve will be evaluated pre- and postoperatively for each patient. It will be determined by plasmatic AMH (anti-Mullerian Hormone) and ultrasound antral follicle count. Women with undetectable preoperative plasmatic AMH will be excluded from the study. Plasmatic AMH and antral follicle count will be measured at 1, 3, 6, 12 and 24 months during the postoperative follow-up.

Limitations:

The sample size is calculated in order to demonstrate a significant difference in plasmatic AMH before and after myomectomy. Small differences are not highlighted in this study, but they probably would not have any impact in clinical practice.

Impact of the study:

The results of this study could have a real impact on daily surgical practice. In case of persistent alteration of ovarian reserve in the experimental group compared to the control group, preventive uterine arteries occlusion during a laparoscopic myomectomy should only be indicated in patients who do not wish pregnancy. If there is no significant impact on ovarian reserve and a beneficial effect on reducing intraoperative blood loss and long-term improvement of symptoms, it should be systematically proposed in all patients undergoing a laparoscopic myomectomy.

Conditions

Uterine Myoma

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Uterine arteries occlusion

Laparoscopic myomectomy with preventive uterine arteries occlusion

Group Type: EXPERIMENTAL

uterine myomectomy with preventive uterine arteries occlusion

Intervention Type: PROCEDURE

laparoscopic uterine myomectomy with preventive uterine arteries occlusion

No uterine arteries occlusion

Laparoscopic myomectomy without preventive uterine arteries occlusion

Group Type: ACTIVE_COMPARATOR

laparoscopic uterine myomectomy without preventive uterine arteries occlusion

Intervention Type: PROCEDURE

laparoscopic uterine myomectomy

Interventions

uterine myomectomy with preventive uterine arteries occlusion

laparoscopic uterine myomectomy with preventive uterine arteries occlusion

Intervention Type: PROCEDURE

laparoscopic uterine myomectomy without preventive uterine arteries occlusion

laparoscopic uterine myomectomy

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• over 18 years
• signed the surgery consent form
• capable of discernment understanding and accepting the risks and benefits of the operation
• symptomatic : menorrhagia, breakthrough bleeding and / or pelvic pain and / or infertility and / or repeated spontaneous abortions.
• uterine myoma or more, including at least one type of myoma FIGO 2-6 (International Federation of Gynecology and Obstetrics) objectified by ultrasound and / or pelvic MRI
• laparoscopic approach is technically feasible (as recommended by the National College of Obstetrics and Gynecology French published in 2011): myoma single lower or equal to 9 cm or sum of the size of myomas in centimeters or less equal to 13 and number of myomas inferior to four.
• Female patients of childbearing age younger than 45 years and having a plasma AMH (anti-Mullerian hormone) than 3 pmol / l.
• Patients who accept a postoperative follow-up of 2 years

Exclusion Criteria

• pregnant patients.
• who underwent radiological uterine artery embolization.
• who have an undetectable AMH levels (<3 pmol / l).
• over 45 years

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 45 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

University Hospital, Geneva

OTHER

Sponsor Role: lead

Responsible Party

Isabelle Streuli

Dr

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Patrick Petignat, Pr

Role: STUDY_DIRECTOR

University Hospital, Geneva

Locations

Hôpitaux Universitaires de Genève, Service de gynécologie

Geneva, , Switzerland

Countries

Switzerland

References

Streuli I, Ramyead L, Silvestrini N, Petignat P, Dubuisson J. Impact of definitive uterine artery occlusion on ovarian reserve markers in laparoscopic myomectomy: a randomized controlled trial with 2-year follow-up. Hum Reprod. 2025 Jul 1;40(7):1305-1314. doi: 10.1093/humrep/deaf070.

Reference Type: DERIVED

PMID: 40420404 (View on PubMed)

Other Identifiers

14-129

Identifier Type: -

Identifier Source: org_study_id