Staged Uterine Artery Embolization Prior to Hysterectomy for Symptomatic Uterine Fibroids: A Narrative Synthesis [ID 993]

INTRODUCTION: Current literature supports uterine artery ligation (UAL) during minimally invasive hysterectomy (MIH) to decrease estimated blood loss (EBL). However, UAL can be technically challenging, as not all gynecologists are familiar with the required training. Uterine artery embolization (UAE) may mimic the effects of UAL. Therefore, staged pre-hysterectomy UAE (SUAE) for symptomatic uterine fibroids may provide similar benefits by decreasing EBL, improving visualization, and increasing chances of successful completion of MIH. METHODS: A systematic review following PRISMA guidelines was performed for articles published on SUAE between January 2010 and February 2023. Results revealed no randomized control trials or prospective or retrospective studies. Therefore, case reports, case studies, and case series were included. Abstracts were reviewed and full-text articles evaluated. Data was extracted using a standardized form and analyzed using summary statistics. RESULTS: Of 1,661 articles identified, 9 (32 patients) met inclusion criteria. Mean preoperative uterine size was 22.7 cm (median 21.5, range 9.5–37.5) and mean interval from UAE to hysterectomy was 14.6 days (median 2, range 0–98). Most hysterectomies were total abdominal (TAH) (84.4%), with 9.4% total laparoscopic, 3.1% subtotal laparoscopic, and 3.1% unspecified. Average uterine weight was 4,472 g (median 2,805, range 1,478–10,800). Average EBL was 118.3 mL (range 50–200). Two patients (6%) required transfusions. Mean postoperative hospital stay was 2.25 days (median 2.5, range 0–4). CONCLUSIONS/IMPLICATIONS: The use of SUAE may facilitate increased access to MIH for symptomatic uterine fibroids while providing similar benefits as UAL.