Hemostatic Effect of Intrauterine Instillation of Oxytocin in Hysteroscopic Myomectomy
Status:
Recruiting
Trial end date:
2022-10-01
Target enrollment:
Participant gender:
Summary
There is no previous study on the hemostatic effect of intrauterine instillation of oxytocin
in hysteroscopic myomectomy. All previous studies focused on intravenous administration of
oxytocin.
This trial may modify the surgical environment in hysteroscopic myomectomy by decreasing
intraoperative bleeding to a degree that the amount of distention medium required for uterine
distention will be reduced with a better visibility and shorter operation time.
The standard treatment of symptomatic myomas is hysterectomy for women who have completed
childbearing period, and myomectomy for women who wish to preserve fertility hysteroscopic
myomectomy currently is the gold standard minimally invasive procedure for the management of
symptomatic submucous fibroids. Success of hysteroscopic myomectomy depends on good
visualization throughout the procedure, via the correct distending pressure, continuous
irrigation and the use of electrosurgery to control bleeding. Prolonged procedures that need
continuous irrigation under high pressure are associated with higher risk of excessive fluid
absorption and intravasation syndrome due to opened blood vessels within the myometrial,
moreover, the thermal damage of the healthy tissues is increased with the use of the
coagulation current.
Oxytocin receptors exist in the non-pregnant uterus but the concentration of the receptors is
much lower than in pregnancy. this is why the clinical use of oxytocin outside of pregnancy
is limited Oxytocin acts on oxytocin receptors in the myometrium and fibroid tissue leading
to uterine contraction and constriction of uterine vasculature due to uterine contraction and
vaso-constrictive effect of oxytocin thus reducing uterine perfusion and results in reducing
intraoperative bleeding.