The Effect of Intramyometrial Injection of Terlipressin Versus Intramyometrial Injection of Carbitocin on Hemoglobin and Blood Loss During Laparoscopic Myomectomy Operations: Double Blinded Randomized Placebo-Controlled Trial

Fibroids are firm benign tumors that are made of smooth muscle cells and fibrous connective tissue. Benign uterine leiomyomas (fibroids) are the most common pelvic tumor in women, affecting 20-40% of all women over the age of 35 and 50% of African American women. Approximately 20-40% of women with fibroids experience significant symptoms and consult gynecologic care. However, their true prevalence is probably underestimated . The most common clinical symptoms include abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility, and recurrent pregnancy loss . Less commonly, women with a uterine mass presumed to be a leiomyoma are found to have a uterine sarcoma or a leiomyoma variant Although hysterectomy is the definitive treatment for myomas, myomectomy remains the gold-standard treatment for women wishing to preserve their uterus and fertility . However, bleeding is often a problem in a myomectomy and can result in intra-operative hypovolaemic shock, post-operative anemia, and delayed recovery .

Three common causes of increased blood loss during abdominal myomectomy are poor surgical technique, the complexity of intra-abdominal pathology (such as low corpus, intra- ligamentous myomas, or obliteration of culde-sac), and the excessive loss of intrauterine blood during dissection of the myomas .

The current treatments for uterine fibroids are many, medical as progesterone's and progesterone antagonist's, surgical, and recent myoma therapies as uterine artery embolization, but surgical resection is still the main treatment, including hysterectomy and myomectomy. With hysterectomy, uterine fibroids can be completely cured, but it cannot keep women's reproductive functions. Despite the rate of relapse, myomectomy is still the most popular surgical treatment for fibroids in women .

A myomectomy excises the fibroid(s) and repairs any defect in the uterine wall, while preserving the uterus. For this reason, myomectomy is an option for women who desire future pregnancies or who wish to retain their uterus. After myomectomy, fibroids could recur, which could lead to subsequent intervention(s) . A laparoscope can be used to remove the fibroid(s) through small incisions in the abdominal wall (laparoscopic) or a hysteroscope can be used to reach the fibroid(s) through the cervix (hysteroscopic).

Although laparoscopic myomectomy has been performed since Semm and colleagues described the procedure in late 1970s , the role of laparoscopic myomectomy as a treatment option for symptomatic uterine fibroids has been questioned. Many fibroids that can be easily removed laparoscopically may not require surgical intervention .