Triple tourniquets at laparoscopic myomectomy

The use of triple tourniquets at open myomectomy is a well established technique for controlling blood loss at open myomectomy. We adapted this approach to haemostasis to laparoscopic myomectomy, tying a No. 1 vicryl suture around the cervix and the infundibulo-pelvic ligaments. Our preliminary experience was very positive although we have yet to subject this technique to a randomized trial.

On the negative side, it may prove impossible to apply all three tourniquets in all patients, particularly access to the cervix is made difficult by a particularly large fibroid sited close to the cervix. It also adds to the operating time, although this decreases with practice.