INTRODUCTION: Minimizing intraoperative bleeding is pivotal in myomectomy, and blockage of the uterine arteries is reported as an effective approach. We developed and published a novel technique to temporarily occlude bilateral uterine arteries at the anterior cul-de-sac (Bronx Blockage) in complex minimally invasive myomectomy (MIM). OBJECTIVE: To evaluate the learning curve of Bronx Blockage and further demonstrate the favorable outcomes of its application in complex MIM. METHODS: This was a case series study conducted at a teaching hospital and tertiary referral center. A consecutive series of 86 patients underwent MIM by a single surgeon between September 2022 and August 2025. The Bronx Blockage was attempted in 61 cases, while 25 cases of MIM were performed without attempting blockage. RESULTS: Among the 61 cases in which Bronx Blockage was attempted, no blockage occurred in 4 cases, unilateral blockage was achieved in 7 cases, and 49 cases had bilateral blockage. The learning curve demonstrated progressive improvement: in the first 30 cases, bilateral occlusion rates ranged from 60–80%, with failures and unilateral occlusions observed. After 34 cases, bilateral success reached 100% and was consistently maintained through case 61. Surgical approaches included laparoscopic myomectomy in 17 patients, laparoscopic-assisted myomectomy (LAM) in 26 patients, and mini-laparotomy in 18 patients. Fibroid removal distribution was as follows: fewer than 3 fibroids in 14 cases, 3–4 fibroids in 8 cases, and 5 and more fibroids in 39 cases. The median size of the largest fibroid was 8.1 cm (IQR 6.2–12.0), and the median specimen weight was 430 g (IQR 205.5–772.5), with 29 cases 1000 g. The median estimated uterine size was 16 weeks (IQR 15–20), with 8 cases 25 weeks. The median operative time was approximately 246 minutes (IQR, 209–281 minutes), and the median estimated blood loss (EBL) was 250 mL (IQR, 100–350 mL). Preoperative hemoglobin averaged 11.8 1.8 mg/dL, with a postoperative hemoglobin drop of 2.1±1.4 mg/dL. One intraoperative vascular complication and one intraoperative transfusion occurred. The median hospital stay was 1 day (IQR 1.0–2.0). Eight patients required postoperative transfusion, two cases experienced Clavien–Dindo class I complications, and no readmissions were reported. CONCLUSIONS: Approximately 34 cases are required for a surgeon to achieve proficiency with Bronx Blockage. Incorporating this technique facilitates the safe and feasible performance of complex MIM.Figure 1Table 1Table 2
Wang et al. (Fri,) studied this question.