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The use of sealing hemostat patch (HEMOPATCH ®) in laparotomic myomectomy: a prospective case-control study. Arch Gynecol Obstet 2023; 307:1521-1528. [PMID: 36790464 DOI: 10.1007/s00404-023-06957-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Uterine myomas are the most common gynecological disease. In these cases, a myomectomy is performed traditionally laparotomically. However, alternatives have been widely used, including laparoscopic, endoscopic, and robotic surgery. During these techniques, diffuse parenchymatous bleeding remains one of the main intraoperative and postoperative complications and sometimes requires unplanned hysterectomies. Recently, hemostatic agents and sealants have been used to prevent excessive blood loss during surgical repair. METHODS We propose a prospective case-control study on the use of a sealing hemostat patch (HEMOPATCH®) on uterine sutures in laparotomic myomectomy. In the period between July 2016 and April 2017, 46 patients with symptomatic uterine fibromatosis underwent surgery. They were divided into two groups of 23 patients, with different treatments in the hemostatic phase of oozing bleeding. HEMOPATCH® is applied in group A, and spray electrocoagulation is applied in group B. RESULTS In group A, we achieve faster hemostasis (p < 0.05), than in group B. We report a significantly lower C-reactive protein value on the second and third days after surgery for group A compared to group B. CONCLUSIONS HEMOPATCH®, during laparotomic myomectomy, is a valid alternative solution for obtaining rapid hemostasis and consequently intraoperative and postoperative bleeding. Furthermore, we suggest that a lower inflammatory peritoneal state is probably correlated with the barrier effect of the patch on the suture.
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Roh CK, Kwon HJ, Jung MJ. Parasitic leiomyoma in the trocar site after laparoscopic myomectomy: A case report. World J Clin Cases 2022; 10:2895-2900. [PMID: 35434089 PMCID: PMC8968796 DOI: 10.12998/wjcc.v10.i9.2895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/13/2022] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic myomectomy is increasingly used for resecting gynecological tumors. Leiomyomas require morcellation for retrieval from the peritoneal cavity. However, morcellated fragments may implant on the peritoneal cavity during retrieval. These fragments may receive a new blood supply from an adjacent structure and develop into parasitic leiomyomas. Parasitic leiomyomas can occur spontaneously or iatrogenically; however, trocar-site implantation is an iatrogenic complication of laparoscopic uterine surgery. We describe a parasitic leiomyoma in the trocar-site after laparoscopic myomectomy with power morcellation.
CASE SUMMARY A 50-year-old woman presented with a palpable abdominal mass without significant medical history. The patient had no related symptoms, such as abdominal pain. Computed tomography findings revealed a well-defined contrast-enhancing mass measuring 2.2 cm, and located on the trocar site of the left abdominal wall. She had undergone laparoscopic removal of uterine fibroids with power morcellation six years ago. The differential diagnosis included endometriosis and neurogenic tumors, such as neurofibroma. The radiologic diagnosis was a desmoid tumor, and surgical excision of the mass on the abdominal wall was successfully performed. The patient recovered from the surgery without complications. Histopathological examination revealed that the specimen resected from the trocar site was a uterine leiomyoma.
CONCLUSION Clinicians should consider the risks and benefits of laparoscopic vs laparotomic myomectomy for gynecological tumors. Considerable caution must be exercised for morcellation to avoid excessive tissue fragmentation.
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Affiliation(s)
- Chul Kyu Roh
- Department of Surgery, National Police Hospital, Seoul 05715, South Korea
| | - Hyuk-Jae Kwon
- Department of Surgery, Ajou University School of Medicine, Suwon 16499, South Korea
| | - Min Jung Jung
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
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Flaxman TE, Cooke CM, Miguel OX, Sheikh AM, Singh SS. A review and guide to creating patient specific 3D printed anatomical models from MRI for benign gynecologic surgery. 3D Print Med 2021; 7:17. [PMID: 34224043 PMCID: PMC8256564 DOI: 10.1186/s41205-021-00107-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Patient specific three-dimensional (3D) models can be derived from two-dimensional medical images, such as magnetic resonance (MR) images. 3D models have been shown to improve anatomical comprehension by providing more accurate assessments of anatomical volumes and better perspectives of structural orientations relative to adjacent structures. The clinical benefit of using patient specific 3D printed models have been highlighted in the fields of orthopaedics, cardiothoracics, and neurosurgery for the purpose of pre-surgical planning. However, reports on the clinical use of 3D printed models in the field of gynecology are limited. Main text This article aims to provide a brief overview of the principles of 3D printing and the steps required to derive patient-specific, anatomically accurate 3D printed models of gynecologic anatomy from MR images. Examples of 3D printed models for uterine fibroids and endometriosis are presented as well as a discussion on the barriers to clinical uptake and the future directions for 3D printing in the field of gynecological surgery. Conclusion Successful gynecologic surgery requires a thorough understanding of the patient’s anatomy and burden of disease. Future use of patient specific 3D printed models is encouraged so the clinical benefit can be better understood and evidence to support their use in standard of care can be provided.
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Affiliation(s)
- Teresa E Flaxman
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada. .,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
| | - Carly M Cooke
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Olivier X Miguel
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada
| | - Adnan M Sheikh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Medical Imaging, The Ottawa Hospital, Ottawa, ON, Canada.,Department of Radiology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sukhbir S Singh
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, 1967 Riverside Dr, 7th Floor, Ottawa, ON, K1H7W9, Canada.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada
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Juan GMS, Yanggui XMS, Bo LMD, Xiaoqin QMD. Evaluating the Curative Effect of Ultrasound-guided Sclerotherapy with Foam Lauromacrogol for Uterine Fibroids. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2021. [DOI: 10.37015/audt.2021.190030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, Locatelli A. Vaginal birth after prior myomectomy. Eur J Obstet Gynecol Reprod Biol 2018; 231:198-203. [PMID: 30396109 DOI: 10.1016/j.ejogrb.2018.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/28/2018] [Accepted: 10/01/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of this retrospective cohort study was to evaluate the obstetrical and perinatal outcomes of vaginal birth in case of pregnancies achieved after prior myomectomy. We also analyzed how operative characteristics at the time of surgery might influence the choice of obstetricians about mode of delivery. STUDY DESIGN We analyzed retrospectively all women who underwent laparoscopic (LPS) or laparotomic (LPT) myomectomy between January 2002 and December 2014, in a network of three Institutions belonging to the University of Milano Bicocca, Italy. Women were contacted by phone interview and only cases with available follow-up data and who had a subsequent pregnancy were included. Operative characteristics and subsequent obstetrical outcomes were recorded and analyzed. RESULTS 469 women who underwent myomectomy were contacted by phone interview, and 152 pregnancies were achieved after surgery, 96 after LPS and 56 after LPT. A total of 110 pregnancies ended in deliveries at ≥24 weeks. Seventy-three (66.4%) women had trial of labor after myomectomy (TOLAM), while 24 (21.8%) had a planned cesarean delivery (CD). Sixty-six (90.4%) of the TOLAM cases successfully accomplished vaginal delivery. No cases of uterine rupture (UR) were reported, and all deliveries ended in live births. The incidence of Neonatal Intensive Care Unit admission was 14.5% (16/110), with no cases of perinatal death. Comparing the surgical details at the time of myomectomy, the incidence of uterine cavity entered was significantly higher in planned CD group compared to TOLAM cases (p < 0.001). No other significant difference between the two groups was reported. CONCLUSIONS A successful vaginal delivery was accomplished by 90.4% of women who had TOLAM, without any case of UR or severe maternal and perinatal complications. TOLAM may be considered and offered as feasible and relatively safe option. Obstetricians' attitude toward mode of delivery after prior myomectomy seems to be influenced by the reported entry into the uterine cavity at the time of surgery.
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Affiliation(s)
| | - C Penati
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
| | - A Carli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - F Accordino
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, San Gerardo Hospital - FMBBM, Monza, Italy
| | - L Ferrari
- Department of Obstetrics and Gynecology, San Gerardo Hospital, ASST Monza, Italy
| | - V Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - A Locatelli
- University of Milano Bicocca, Milan, Italy; Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Vimercate, Italy
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Martinez MEG, Domingo MVC. Size, Type, and Location of Myoma as Predictors for Successful Laparoscopic Myomectomy: A Tertiary Government Hospital Experience. Gynecol Minim Invasive Ther 2018; 7:61-65. [PMID: 30254939 PMCID: PMC6113999 DOI: 10.4103/gmit.gmit_12_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM. Methodology: Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed. Results: There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010). Conclusion: LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.
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Affiliation(s)
- Mikaela Erlinda G Martinez
- Department of Obstetrics and Gynecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Madonna Victoria C Domingo
- Department of Obstetrics and Gynecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
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Prise en charge des léiomyomes utérins. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S550-S576. [PMID: 28063565 DOI: 10.1016/j.jogc.2016.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gambacorti-Passerini Z, Gimovsky AC, Locatelli A, Berghella V. Trial of labor after myomectomy and uterine rupture: a systematic review. Acta Obstet Gynecol Scand 2016; 95:724-34. [DOI: 10.1111/aogs.12920] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Alexis C. Gimovsky
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
| | - Anna Locatelli
- Department of Obstetrics and Gynecology; University of Milan Bicocca; Milan Italy
| | - Vincenzo Berghella
- Division of Maternal Fetal Medicine; Department of Obstetrics and Gynecology; Sidney Kimmel College of Medicine; Thomas Jefferson University; Philadelphia PA USA
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Robot-Assisted Myomectomy for Large Uterine Myomas: A Single Center Experience. Minim Invasive Surg 2016; 2016:4905292. [PMID: 27034828 PMCID: PMC4789429 DOI: 10.1155/2016/4905292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/02/2016] [Indexed: 11/21/2022] Open
Abstract
Objective. To determine if robot-assisted myomectomy (RAM) is feasible for women with large uterine myomas. Methods. Retrospective review of one gynecologic surgeon's RAM cases between May 2010 and July 2013. Large uterine myomas, defined as the largest myoma ≥9 cm by preoperative magnetic resonance imaging, was age- and time-matched to controls with the largest myoma <9 cm. Primary surgical outcomes compared were operative time and estimated blood loss (EBL). Results. 207 patients were included: 66 (32%) patients were in the ≥9 cm group, while 141 (68%) patients were in the <9 cm group. There was a statistically significant increase in the operative time (130 min versus 92 min) and EBL (100 mL versus 25 mL) for the ≥9 cm group compared to the <9 cm group. Ten (4.8%) patients had the largest myoma measuring ≥15 cm, and 11 (5.3%) patients had a specimen weight >900 gm, of which no major adverse outcomes were observed. All patients in the study cohort were discharged on the same day after surgery. Conclusion. RAM is a feasible surgical approach for patients with myomas ≥9 cm. Patients with large myomas undergoing RAM are also candidates for same-day discharge after surgery.
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Tsai HW, Ocampo EJ, Huang BS, Twu NF, Wang PH, Yen MS, Kung YS, Chen YJ. Effect of semisimultaneous morcellation in situ during laparoscopic myomectomy. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bernardi TS, Radosa MP, Weisheit A, Diebolder H, Schneider U, Schleussner E, Runnebaum IB. Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch Gynecol Obstet 2014; 290:87-91. [DOI: 10.1007/s00404-014-3155-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
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Sankaran S, Odejinmi F. Prospective evaluation of 125 consecutive laparoscopic myomectomies. J OBSTET GYNAECOL 2013; 33:609-12. [DOI: 10.3109/01443615.2012.762348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE Venous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography. MATERIALS AND METHODS In this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading. RESULTS In the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001). CONCLUSION The incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.
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Affiliation(s)
- Jiwon An
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seo Kyung Shin
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ja-Young Kwon
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Tinelli A, Hurst BS, Mettler L, Tsin DA, Pellegrino M, Nicolardi G, Dell'Edera D, Malvasi A. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study. Hum Reprod 2012; 27:2664-2670. [DOI: 10.1093/humrep/des212] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Talaulikar VS, Manyonda I. Progesterone and progesterone receptor modulators in the management of symptomatic uterine fibroids. Eur J Obstet Gynecol Reprod Biol 2012; 165:135-40. [PMID: 22901974 DOI: 10.1016/j.ejogrb.2012.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 06/03/2012] [Accepted: 07/25/2012] [Indexed: 10/28/2022]
Abstract
The majority of symptomatic uterine fibroids are currently treated by surgical interventions (myomectomy or hysterectomy) or radiological treatments (uterine artery embolisation or focussed ultrasound surgery). None of these treatments is a panacea, and what is conspicuous is the lack of an effective long-term medical therapy for a disorder so common among women of reproductive age. It has been known for some time that progesterone and its receptors enhance proliferative activity in fibroids and this has raised the possibility that anti-progestins and (PRMs) could be useful in the medical management of fibroids. Some of the compounds which have produced promising results in recent clinical trials or research studies include mifepristone, CDB-4124 (telapristone), CP-8947, J-867 (asoprisnil) and CDB-2914 (ulipristal acetate or UA). UA has recently completed Phase III clinical trials with very encouraging results, and has now acquired a licence for clinical use in Europe. While considerable research has yet to be done on the long-term safety and efficacy of UA there is nevertheless good reason for optimism on the emergence of effective medical therapy in the form of UA and possibly other PRMs.
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Affiliation(s)
- Vikram Sinai Talaulikar
- Department of Obstetrics & Gynaecology, St. George's Hospital and University of London, Cranmer Terrace, Tooting, London SW17 0RE, United Kingdom.
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Talaulikar VS, Manyonda IT. Ulipristal acetate: a novel option for the medical management of symptomatic uterine fibroids. Adv Ther 2012; 29:655-63. [PMID: 22903240 DOI: 10.1007/s12325-012-0042-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Indexed: 11/26/2022]
Abstract
Fibroids, the most common tumor in women of reproductive age, impact negatively on women's health and quality of life, and have significant cost implications for their management. The current mainstay treatments are surgical (myomectomy and hysterectomy) and more recently radiological (UAE and focused ultrasound surgery). Hysterectomy is curative but precludes future fertility, whereas the impact of the other treatments on reproduction is uncertain. With women in Western societies deferring childbearing to their 30s and 40s, when fibroids are most symptomatic, there is a pressing need for a uterus-sparing medical therapy that is cheap, effective, and enhances reproductive potential. Serendipity and meticulous translational research has shown that progesterone augments fibroid proliferation, raising the possibility that progesterone receptor modulators could inhibit fibroid growth; this research has culminated in the emergence of ulipristal acetate (UA), a first-in-class, oral selective progesterone receptor modulator (SPRM) that has successfully completed phase III clinical trials. It has been licensed in Western Europe for short-term clinical use prior to surgery, and has shown efficacy with a significant reduction in uterine bleeding, fibroid volume, and improved quality of life, without the side effects associated with other medications such as gonadotropin-releasing hormone (GnRH) agonists. As with all new medicines, there are concerns surrounding UA, not least its effect on the endometrium and the long-term impact on general health and reproduction. Research to date has tended to be industry led, and therefore, there is a need for researcher/clinician-led studies to address the wider issues concerning SPRMs. UA may not turn out to be the "Holy Grail" of medical therapy in the treatment of symptomatic uterine fibroids, but it has rightly given cause for a huge optimism. Further laboratory and clinical research into PRMs and related compounds will no doubt lead to more refined medications.
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Affiliation(s)
- Vikram S Talaulikar
- Department of Obstetrics & Gynaecology, St. George's Hospital and University of London, Cranmer Terrace, London, SW17 0RE, UK
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Sesti F, Pietropolli A, Sesti FF, Piccione E. Uterine myomectomy: Role of gasless laparoscopy in comparison with other minimally invasive approaches. MINIM INVASIV THER 2012; 22:1-8. [DOI: 10.3109/13645706.2012.680889] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Angioli R, Plotti F, Ricciardi R, Terranova C, Zullo MA, Damiani P, Montera R, Guzzo F, Scaletta G, Muzii L. The use of novel hemostatic sealant (Tisseel) in laparoscopic myomectomy: a case-control study. Surg Endosc 2012; 26:2046-53. [PMID: 22302534 DOI: 10.1007/s00464-012-2154-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/20/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND This is the first case-control study on the use of a fibrin sealant (Tisseel) on uterine suture during laparoscopic myomectomy (LM), with the primary endpoint to evaluate the intraoperative bleeding and postoperative blood loss. In addition, we evaluated the time required to achieve hemostasis using Tisseel and how much it can influence operative time. METHODS From December 2009 to January 2011, consecutive patients older than 18 years with symptomatic isolate intramural myoma with maximal diameter B6 cm and ≥ 4 cm and with a sonographically diagnosed free myometrium margin ≥ 0.5 cm were included in the study. We selected from our institute's database a group of consecutive patients with homogeneous features of the study group, who underwent laparoscopic myomectomy without Tisseel application. RESULTS Fifteen women with symptomatic myoma were enrolled in the study (group A). Regarding the control group (group B), we selected a homogenous group of 15 patients with the same preoperative characteristics of the study group. Mean operative time was 47.7 min and 62.1 min, for groups A and B respectively (p < 0.05). Mean time required to achieve complete haemostasis was 195.5 s in group A and 361.8 in control group B (p < 0.0001). Mean estimated blood loss was 111.3 mL and 230 mL in groups A and B, respectively (p < 0.05). Mean hemoglobin decrease was 1.36 g/dL and 2.04 g/dL in groups A and B, respectively (p < 0.05). CONCLUSIONS The use of Tisseel during LM may represent a valid alternative solution for obtaining hemostasis, reducing intra- and postoperative bleeding. Furthermore, it may help the surgeon to obtain a rapid healing of the injured surfaces, probably reducing the use of electrocoagulationand traumatisms.
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Affiliation(s)
- Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio Medico University of Rome, Via Álvaro del Portillo, 200-00128 Rome, Italy.
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Gillaux C, Panel P. [Surgical treatment of subserosal fibroids: the pros]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2011; 39:458-461. [PMID: 21752684 DOI: 10.1016/j.gyobfe.2011.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- C Gillaux
- Service de gynécologie-obstétrique du centre hospitalier de Versailles André-Mignot, 177 rue de Versailles, Le Chesnay cedex, France
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Fan TY, Zhang L, Chen W, Liu Y, He M, Huang X, Orsi F, Wang Z. Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis. Eur J Radiol 2011; 81:3624-30. [PMID: 21719223 DOI: 10.1016/j.ejrad.2011.05.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To test the feasibility of MRI-guided high intensity focused ultrasound ablation for adenomyosis. MATERIALS AND METHODS Patients with symptomatic adenomyosis were treated with MRI-guided high intensity focused ultrasound (MRIgHIFU). Under conscious sedation, MRIgHIFU was performed by a clinical MRI-compatible focused ultrasound tumour therapeutic system (JM15100, Haifu® Technology Co. Ltd., Chongqing, China) which is combined with a 1.5 T MRI system (Magnetom Symphony, Siemens Healthcare, Erlangen, Germany). MRI was used to calculate the volume of the uterus and lesion. Non-perfused volume of the targeted lesions was evaluated immediately after MRIgHIFU. Patient symptoms were assessed using symptom severity score (SSS) and uterine fibroids symptoms and quality of life questionnaire (UFS-QOL). RESULTS Ten patients with mean age of 40.3±4 years with an average lesion size of 56.9±12.7 mm in diameter were treated. Non-perfused volume and the percentage of non-perfused volume obtained from contrast-enhanced T1 Magnetic resonance images immediately post-treatment were 66.6±49.4 cm3 and 62.5±21.6%, respectively. The mean SSS and UFS-QOL showed significant improvements of 25%, 16% and 25% at 3, 6 and 12 months follow up, respectively, to pre-treatment scores. No serious complications were observed. CONCLUSION Based on the results from this study, MRIgHIFU treatment appears to be a safe and feasible modality to ablate adenomyosis lesion and alleviate its symptoms.
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Affiliation(s)
- Tien-Ying Fan
- State Key Laboratory of Ultrasound Engineering in Medicine, Department of Biomedical Engineering, Chongqing Medical University, Clinical Center of Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Apestegui C, Tamer S, Ciccarelli O, Bonaccorsi-Riani E, Marbaix E, Lerut J. Leiomyoma mimicking an incarcerated inguinal hernia: A rare complication of laparoscopic hysterectomy. J Minim Access Surg 2011; 7:151-153. [PMID: 21523240 PMCID: PMC3078480 DOI: 10.4103/0972-9941.78351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Accepted: 05/19/2010] [Indexed: 11/04/2022] Open
Abstract
A 52-year-old, obese, female patient was referred for a right inguinal mass, which appeared seven months after a laparoscopic hysterectomy, which was performed because of myomatosis. Despite several examinations, including ultrasound, computed tomography (CT)-Scan, positron emission tomography (PET)-CT, and ultrasound-guided biopsy, the diagnosis remained unclear until surgical exploration, which disclosed a well-encapsulated solid tumour corresponding to a fibrotic leiomyoma. Spilling of leiomyoma cells is a rare and unusual complication of laparoscopic surgery. Tumour development in the inguinal canal after laparoscopic gynaecological surgery should be kept in mind in the differential diagnosis of inguinal hernia and other uncommon pathologies.
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Affiliation(s)
- Carlos Apestegui
- Department of Abdominal and Transplantation Surgery University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
| | - Saadallah Tamer
- Department of Abdominal and Transplantation Surgery University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
| | - Olga Ciccarelli
- Department of Abdominal and Transplantation Surgery University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
| | - Eliano Bonaccorsi-Riani
- Department of Abdominal and Transplantation Surgery University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
| | - Etienne Marbaix
- Department of Abdominal and Transplantation Pathology, University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
| | - Jan Lerut
- Department of Abdominal and Transplantation Surgery University Hospitals Saint-Luc, Université Catholique de Louvain - UCL, 1200 Brussels-Belgium
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Paul GP, NAIK SA, Madhu KN, THOMAS T. Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases. Aust N Z J Obstet Gynaecol 2010; 50:385-90. [DOI: 10.1111/j.1479-828x.2010.01191.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laparoscopic transient uterine artery occlusion and myomectomy for symptomatic uterine myoma. Fertil Steril 2010; 95:254-8. [PMID: 21168582 DOI: 10.1016/j.fertnstert.2010.05.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Revised: 04/20/2010] [Accepted: 05/11/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare clinical outcomes of laparoscopic transient uterine artery ligation plus myomectomy (LTUAL) to simple laparoscopic myomectomy (LM) for symptomatic myomas. DESIGN Comparative observational study. SETTING Medical centers. PATIENT(S) One hundred sixty-seven patients with symptomatic myomas. INTERVENTION(S) Eighty-four patients underwent LTUAL and LM; 83 patients underwent LM only. MAIN OUTCOME MEASURE(S) Operative time, blood loss, gonadal hormone level, uterine artery resistance index, menorrhea, pregnancy rate, and recurrence rate of myoma. RESULT(S) The intraoperative blood loss in the LTUAL group was lower than in the LM group. The menstrual blood volume (MBV) and the menstrual period of the LTUAO group was unchanged after operation relative to the prediseased volume. No significant difference was found in the resistance index of the uterine artery blood flow, the recurrence rate, and the fertility rate between the LTUAL and LM groups. CONCLUSION(S) LTUAL and LM are a promising surgical treatment for symptomatic uterine myoma and did not produce any appreciable adverse effect on fertility.
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Ono M, Inoue Y, Yokota M, Uehara I, Kamijo S, Hattori Y, Kurahashi T, Shimada T, Nakagawa H. Abdominal wall leiomyoma in a reproductive age woman without antecedent pelvic surgery. Eur J Obstet Gynecol Reprod Biol 2010; 151:225-6. [PMID: 20483529 DOI: 10.1016/j.ejogrb.2010.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 04/19/2010] [Accepted: 04/25/2010] [Indexed: 12/26/2022]
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Liberis V, Tsikouras P, Ammari A, Zografou C, Valentina D, Kafetzis D, Maroulis G. Assessment of the feasibility of bipolar coagulation use to reduce hemorrhage in myomectomy performed by minilaparotomy. MINIM INVASIV THER 2010; 19:75-82. [DOI: 10.3109/13645701003642875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Liu G, Zolis L, Kung R, Melchior M, Singh S, Francis Cook E. The Laparoscopic Myomectomy: A Survey of Canadian Gynaecologists. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:139-148. [DOI: 10.1016/s1701-2163(16)34428-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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[Treatment of surgical wounds on the uterus after laparoscopic myomectomy]. SRP ARK CELOK LEK 2010; 137:641-6. [PMID: 20069922 DOI: 10.2298/sarh0912641s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The advantages of laparoscopic removal of a myoma over classical surgical technique are shorter hospital stay, rapid recovery and less pain after surgery, as well as a lower frequency of ileus and thromboembolic complications. The surgical technique of laparoscopic removal of myoma involves four basic stages: incision on the wall of the uterus, separation of the myoma from the healthy uterine tissue, to stop bleeding and removal of the myoma from the abdomen. Apart from these four basic stages, it is also necessary to establish a new integrity of the uterine wall, especially in women planning pregnancy. OBJECTIVE The aim of the paper is to present the procedures used in the treatment of uterine wall defect during the laparoscopic removal of the myoma. METHODS We analysed 96 patients who were indicated for laparoscopic myomectomy. All patients were divided into four groups according to the type of the technique of haemostasis and treatment of the defect on the uterine wall: electrocoagulation, electrocoagulation with application of argon plasma, a single suture and extended suture. RESULTS In order to stop bleeding, we most often used electrocoagulation by monopolar electricity, i.e. in 39.6% of the patients. To stop bleeding and treat the defect of the uterine wall, we used a single suture in 21.9% and in 11.4% patients we used the extended suture. The manner of uterine wall treatment did not have a statistically significant influence on the results of haematological parameters (p > 0.05), consumption of carbon dioxide (p > 0.05) and the duration of surgical procedure (p > 0.05). The increased use of antibiotics (p < 0.05) in the group of patients in whom we treated the defect by sutures on the uterus, the length of postsurgical hospitalisation and absence from work (p < 0.01) was statistically significant. CONCLUSION To achieve a better reconstruction of the uterus, it is recommended to use sutures with laparoscopic removal of myoma.
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Elahi SM, Odejinmi F. Overview of current surgical management of fibroids: ‘Organ-preserving modalities’. J OBSTET GYNAECOL 2009; 28:28-31. [DOI: 10.1080/01443610701814328] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Monsarrat N, Collinet P, Narducci F, Leblanc E, Vinatier D. [Robotic assistance in gynaecological surgery: State-of-the-art]. ACTA ACUST UNITED AC 2009; 37:415-24. [PMID: 19398363 DOI: 10.1016/j.gyobfe.2009.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Accepted: 03/25/2009] [Indexed: 11/19/2022]
Abstract
From the Automated Endoscopic System for Optimal Positioning (AESOP), a robotic arm which operates the laparoscope, to the robots Zeus and da Vinci, robotic assistance in gynaecological endoscopic surgery has continuously evolved for the last fifteen years or so. It has brought about new technical advancements: the last generation robots offer a steady three-dimensional image, improved instrument dexterity and precision, higher ergonomics and comfort for the surgeon. The da Vinci robotic system has been used without evincing any specific morbidity in various cases, notably for tubal reanastomosis, myomectomy, hysterectomy, pelvic and para-aortic lymphadenectomy or sacrocolpopexy amongst others. Robotic assistance in gynaecology is thus feasible. Like conventional laparoscopic surgery, it allows decreased blood loss and morbidity as well as shorter hospital stay, as compared to laparotomy. It might indeed allow many surgical teams to perform minimally invasive surgical procedures which they were not used to performing by laparoscopy. Randomized prospective studies are needed to define its indications more precisely. Besides, its medico-financial impact should be evaluated too.
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Affiliation(s)
- N Monsarrat
- Pôle de gynécologie-obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 59037 Lille cedex, France.
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Moon HS, Koo JS, Park SH, Park GS, Choi JG, Kim SG. Parasitic leiomyoma in the abdominal wall after laparoscopic myomectomy. Fertil Steril 2008; 90:1201.e1-2. [DOI: 10.1016/j.fertnstert.2007.08.068] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 08/31/2007] [Accepted: 08/31/2007] [Indexed: 01/12/2023]
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Mukhopadhaya N, De Silva C, Manyonda IT. Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 2008; 22:677-705. [DOI: 10.1016/j.bpobgyn.2008.01.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Torng PL, Hwang JS, Huang SC, Chang WC, Chen SY, Chang DY, Hsu WC. Effect of simultaneous morcellation in situ on operative time during laparoscopic myomectomy. Hum Reprod 2008; 23:2220-6. [PMID: 18617593 DOI: 10.1093/humrep/den256] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Laparoscopic myomectomy (LM) is technically difficult and time consuming procedure that requires surgical skill and modifications. The aim of this study was to assess factors which affect operative times in LM. METHODS From March 2003 to June 2007, 174 women, who underwent LM for symptomatic myomas, were enrolled. Standard LM was performed in the first 4 years and simultaneous morcellation in situ (SMI) method was applied in the fifth year. RESULTS The mean myoma weight was 213.5 +/- 190.4 g and the mean operative time was 117.0 +/- 39.6 min. No laparoconversions occurred and there was a 2.3% rate of complications. Total myoma weight increased and operative time declined significantly over time. The surgeon's learning curve and the effect of SMI on operative time were identified by establishing a nonlinear multiple regression model. Model assumptions showed little violation by residual plots. Slopes of the average myoma weight (total myoma weight/number of myoma operated) for describing the operative time declined along with the study year, suggesting that operative experience is a major factor influencing operative time. SMI showed a further 19 min reduction in the predicted operative time. CONCLUSIONS Operative time in LM is dependent on a multitude of factors including surgical experience. Applying SMI during LM is an efficient way to further reduce operative time.
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Affiliation(s)
- Pao-Ling Torng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Kumakiri J, Takeuchi H, Itoh S, Kitade M, Kikuchi I, Shimanuki H, Kumakiri Y, Kuroda K, Takeda S. Prospective evaluation for the feasibility and safety of vaginal birth after laparoscopic myomectomy. J Minim Invasive Gynecol 2008; 15:420-4. [PMID: 18602046 DOI: 10.1016/j.jmig.2008.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 04/04/2008] [Accepted: 04/13/2008] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To estimate the feasibility and safety of vaginal birth after laparoscopic myomectomy (LM). DESIGN Prospective clinical study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS The study was performed on 1334 patients who underwent LM at our hospital from January 2000 through December 2005. INTERVENTIONS Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS The potential of a safe vaginal birth after LM was discussed with all 1334 patients before and after their LM. A strict protocol for a vaginal birth after LM was prepared using the criteria for a vaginal birth after cesarean section (CS). Of the 221 women who became pregnant after LM by December 2006, 111 were scheduled to deliver at our hospital. The findings at LM in these patients were as follows: mean diameter of the largest myoma (mean +/- SD, 95% CI), 66.1 +/- 18.8 (62.6-69.6) mm; and mean number of enucleated myomas, 3.5 +/- 3.6 (2.8-4.2). The endometrium was opened in 13 patients. Of the 111 patients, 82 patients opted for a vaginal delivery and 29 patients requested a CS. Of the 82 patients, 8 underwent an elective CS because of complications of pregnancy. Vaginal delivery was completed in 59 (79.7%) of the remaining 74 patients. The 15 patients who failed vaginal delivery underwent a CS: eleven because of failure to progress in labor or absence of spontaneous labor by 42 weeks of gestation; and 4 because of a nonreassuring fetal status during labor. No significant differences in delivery outcomes existed between the successful and failed group. None of the patients had a uterine rupture. CONCLUSION Uterine rupture during pregnancy after LM is rare, and vaginal birth after LM appears to be safe in selected patients who meet our criteria.
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Affiliation(s)
- Jun Kumakiri
- Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Tokyo, Japan.
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Tan J, Sun Y, Dai H, Zhong B, Wang D. A Randomized Trial of Laparoscopic Versus Laparoscopic-Assisted Minilaparotomy Myomectomy for Removal of Large Uterine Myoma: Short-Term Outcomes. J Minim Invasive Gynecol 2008; 15:402-9. [DOI: 10.1016/j.jmig.2008.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 03/18/2008] [Accepted: 03/21/2008] [Indexed: 10/21/2022]
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Abstract
The ideal medical therapy for fibroids is, arguably, a tablet that is taken by mouth, once a day or, even better, once a week, with minimal, if any, side-effects, that induces fibroid regression and thus a resolution of symptoms rapidly, but without affecting fertility. Such a magic bullet does not yet exist, and there are no indications that one is on the horizon. Driven by the observation that fibroid growth is hormone dependent, current medical treatments mainly involve hormonal manipulations. Gonadotrophin-releasing hormone analogues (GnRHa) have been the most widely used, and while they do cause fibroid regression, they can only be used in the short term, as temporizing measures in the perimenopausal woman, or pre-operatively to reduce fibroid size, influence the type of surgery, restore haemoglobin levels and apparently reduce blood loss at operation. They are notorious for rebound growth of the fibroids upon cessation of therapy, and have major side-effects. GnRH antagonists avoid the initial flare effect seen with GnRHa therapy, but otherwise do not appear to have any additional advantages over GnRHa. Selective oestrogen receptor modulators, such as raloxifene, have been shown to induce fibroid regression effectively in post-, but not pre-, menopausal women; even in the former group, experience with these drugs is limited, and they are associated with significant side-effects. Aromatase inhibitors only appear to be effective in postmenopausal women, have potentially significant long-term side-effects, and experience with their use is also limited. There are suggestions that the levonorgestrel intra-uterine system can cause dramatic reduction in menstrual flow in women with fibroids, but to date there have been no RCTs of its use in these women, in whom rates of expulsion of the device appear to be high. The progesterone antagonists mifepristone and asoprisnil have shown significant promise and warrant further research, as they appear to show efficacy in inducing fibroid regression without major side-effects. However, they and the other hormonal therapies that alter oestrogen and progesterone production or function significantly (danazol, gestrinone) are not compatible with reproduction. Therefore, the quest for the ideal medical therapy for fibroid disease continues, and increasing understanding of fibroid biology is ushering in non-hormonal therapies, although all are confined to laboratory experimentation at present. In the meantime, surgical and radiological approaches remain the mainstay effective therapies.
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Affiliation(s)
- Srividhya Sankaran
- St George's Hospital NHS Trust, Department of Obstetrics and Gynaecology, Blackshaw Road, London SW17 0QT, UK
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Manyonda IT, Gorti M. Commentary: Costing magnetic resonance-guided focused ultrasound surgery, a new treatment for symptomatic fibroids. BJOG 2008; 115:551-3. [DOI: 10.1111/j.1471-0528.2007.01656.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Malartic C, Morel O, Akerman G, Tulpin L, Clément D, Barranger E. La myomectomie par cœlioscopie en 2007: état des lieux. ACTA ACUST UNITED AC 2007; 36:567-76. [PMID: 17597308 DOI: 10.1016/j.jgyn.2007.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/10/2007] [Accepted: 05/09/2007] [Indexed: 11/30/2022]
Abstract
With fifteen years of development, laparoscopy for myomectomy has proven its advantages. However, this technique remains controversial concerning its feasibility and the quality of uterine scar obtained. Laparoscopic myomectomy (LM) is usually indicated when number of myomas is less than 3 to 4 with a 8 to 9 cm maximal size. Surgical technique is standardized and intervention time becomes acceptable. Risk of conversion ranges between 1 to 3% when technique is realized by trained surgeon. Bleeding is less important compared with laparotomy and immediate postoperative complications are exceptional. Results concerning fertility are positive with more than 50% of infertile patient conceiving after surgery, this rate rising up to 61 to 76% for myomas isolated cause for infertility; these values can be compared with myomectomy realized by laparotomy. Postoperative adhesions seem to be less important after laparoscopy when compared with laparotomy but this point needs to be confirmed. Risk of uterine rupture is estimated between 0 to 1%, but this point needs for larger series evaluation and needs to be compared with pregnancies after laparotomy. Laparoscopic myomectomy is a feasible technique, safe for patients waiting for conception and has proven its interest in case of infertility.
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Affiliation(s)
- C Malartic
- Service de gynécologie-obstétrique, APHP, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
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Sesti F, Capobianco F, Capozzolo T, Pietropolli A, Piccione E. Isobaric gasless laparoscopy versus minilaparotomy in uterine myomectomy: a randomized trial. Surg Endosc 2007; 22:917-23. [PMID: 17705083 DOI: 10.1007/s00464-007-9516-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Revised: 04/06/2007] [Accepted: 05/07/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Isobaric gasless laparoscopy and minilaparotomy have been used as more recent minimally invasive approaches to myomectomy. This randomized trial aimed to compare the surgical and immediate postoperative outcomes for myomectomy performed by isobaric gasless laparoscopy with those for minilaparotomy. METHODS A total of 100 patients with symptomatic uterine myomas requiring myomectomy were randomly allocated to the gasless laparoscopy group or the minilaparotomy group. The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the discharge times between the two procedures. A power calculation verified that more than 26 patients for each group was necessary to detect a difference of more than 24 h in discharge time with an alpha error level of 5% and a beta error of 80%. Continuous outcome variables were analyzed using the Student's t-test. Discrete variables were analyzed with the chi-square test or Fisher's exact test. A p value less than 0.05 was considered statistically significant. RESULTS The mean discharge time was longer for minilaparotomy than for gasless laparoscopy (98.4 +/- 1.4 vs 52.8 +/- 1.6 h; p < 0.001). Gasless laparoscopy resulted in shorter times for canalization (21.6 +/- 1.1 vs 32 +/- 1.3 h; p < 0.05) and surgery (79.5 +/- 25.1 vs 103.5 +/- 24.9 min; p < 0.001). The intraoperative blood loss was less with gasless laparoscopy (154.2 +/- 1.2 vs 188.6 +/- 1.3 ml; p < 0.001). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary. CONCLUSIONS Isobaric gasless laparoscopy and minilaparotomy can be suitable options for uterine myomectomy. Several surgical and immediate postoperative outcomes were significantly better in the gasless laparoscopy group than in the minilaparotomy group. However, further controlled prospective studies are required to confirm the results.
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Affiliation(s)
- F Sesti
- Section of Gynecology and Obstetrics, Department of Surgery, School of Medicine, Tor Vergata Hospital University of Rome, Viale Oxford 81, 00133, Rome, Italy.
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El-Shawarby SA, Hassan M, Gangooly S, Chandakas S, Hill N, Erian J. A novel application of the Lap Loop system in day case laparoscopic myomectomy prior to IVF. J OBSTET GYNAECOL 2007; 27:437-8. [PMID: 17654211 DOI: 10.1080/01443610701359605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S A El-Shawarby
- Department of Obstetrics and Gynaecology, Minimal Access Surgery Unit, Princess Royal University Hospital, Orpington, Kent, UK.
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Yuen LT, Hsu LJ, Lee CL, Wang CJ, Soong YK. A modified suture technique for laparoscopic myomectomy. J Minim Invasive Gynecol 2007; 14:318-23. [PMID: 17478362 DOI: 10.1016/j.jmig.2006.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Revised: 11/06/2006] [Accepted: 11/18/2006] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The safety and efficacy of a modified laparoscopic suture performed by a surgeon assisted by an under-training assistant in the repair of uterine defect during laparoscopic myomectomy (LM) was evaluated. DESIGN Prospective clinical study (Canadian Task Force classification II-2). SETTING Tertiary care university hospital. PATIENTS Sixty-two women scheduled for myomectomy because of symptomatic uterine myomas. INTERVENTION Group A (n = 31): LM with a modified laparoscopic suture technique (the suture line was pulled out of the trocar, and tension of the suture was maintained by the surgeon's or assistant's hand). Group B (n = 31): LM with a traditional laparoscopic suture technique (intracorporeal continuous suturing with a string trimmed to 30 cm). MEASUREMENTS AND MAIN RESULTS The median operative time (100 minutes vs 90 minutes, p = .436) and blood loss (200 mL vs 150 mL, p = .771) were slightly greater in the LM with a modified laparoscopic suture technique group (group A), although these differences were not statistically significant. The total specimen weight, number of myomas removed, and length of hospital stay were similar in both groups. No patients in either group had serious complications. CONCLUSION A modified laparoscopic suture by controlling the tail of the suture with the surgeon's hand while sewing laparoscopically can achieve a good approximation of uterine defect and is an acceptable alternative to help laparoscopic surgeons performing surgery assisted by an under-training assistant to complete the procedure.
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Affiliation(s)
- Leung-To Yuen
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
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Takeda A, Sakai K, Mitsui T, Nakamura H. Wound retraction system for gasless laparoscopic-assisted myomectomy with a subcutaneous abdominal wall-lift method. J Minim Invasive Gynecol 2007; 14:240-6. [PMID: 17368264 DOI: 10.1016/j.jmig.2006.07.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 07/15/2006] [Accepted: 07/16/2006] [Indexed: 11/28/2022]
Abstract
Over the course of 4 years we evaluated 209 women using gasless laparoscopic-assisted myomectomy and a wound retractor. Three were no significant differences in blood loss or surgical duration despite myoma size or location. Gasless laparoscopic-assisted myomectomy utilizing a wound retractor is an effective procedure for women desiring uterine preservation without significantly longer surgery duration.
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Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.
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Hsu WC, Hwang JS, Chang WC, Huang SC, Sheu BC, Torng PL. Prediction of operation time for laparoscopic myomectomy by ultrasound measurements. Surg Endosc 2007; 21:1600-6. [PMID: 17294306 DOI: 10.1007/s00464-006-9189-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 11/20/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study aimed to develop a regression-based prediction equation for operation time for laparoscopic myomectomy (LM) using ultrasound measurement. METHODS Patients who were to undergo laparoscopic myomectomy from March 2003 to December 2005 were enrolled prospectively in a tertiary institution. Ultrasound was performed before operation. The myoma weights were calculated and converted into mass units (g) by an assumed smooth muscle density of 1.04 g/cm3. Myomas were weighed immediately after operation, and the correlation between these two weights was assessed by linear regression and limits of agreement. A multivariate linear regression model was fitted to the ultrasound parameters and clinical variables to predict operation time. RESULTS Of 109 patients, 203 myomas were removed laparoscopically with a mean ultrasound-measured myoma weight of 137.9 (100.7) g, a diameter of the dominant myoma of 6.30 (1.92) cm, and an operation time of 125 (41) min. Strong correlations were observed between the ultrasound-measured and operated myoma weights. A predictive model, in which operation time = 0.14 x ultrasound-measured myoma weight + 1.68 x BMI + 5.21 x operated myoma number + 0.06 x (ultrasound-measured myoma weight x operated myoma number) + 43.97, was developed. CONCLUSIONS Operation time was significantly related to the myoma weight measured by ultrasound. The ultrasound-derived prediction equation is valid and reliable in predicting operation time for LM.
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Affiliation(s)
- Wen-Chiung Hsu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Sesti F, Melgrati L, Damiani A, Piccione E. Isobaric (gasless) laparoscopic uterine myomectomy. Eur J Obstet Gynecol Reprod Biol 2006; 129:9-14. [PMID: 16723181 DOI: 10.1016/j.ejogrb.2006.04.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 03/11/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
The aim of this review has been to assess the usefulness and effectiveness of isobaric (gasless) laparoscopic myomectomy using a subcutaneous abdominal wall lifting system, and to evaluate the advantages and disadvantages of this technique in comparison with the conventional laparoscopic myomectomy using pneumoperitoneum. Laparoscopy using CO2 is more frequently employed for small or medium-sized myomas. Furthermore, multiple myomectomies (>or=3 myomas per patient) are performed rarely. Gasless laparoscopy permits the removal of large intramural myomas overcoming the difficulties associated with laparoscopic myomectomy using pneumoperitoneum. It appears to offer several advantages over conventional laparoscopy, such as elimination of the adverse effects and potential risks associated with CO2 insufflation; use of conventional laparotomy instruments that facilitate several steps of the procedure; reduced operative times and costs. Indeed, this procedure associates the advantages of laparoscopy and minimal access surgery with those of using the laparotomic instruments that are more reliable for uterine closure. The only advantage of the laparoscopy with pneumoperitoneum is the tamponade effect generated by the gas on the small vessels, thus reducing intraoperative bleeding. Laparoscopic myomectomy using CO2 remains the preferred minimally invasive approach for small and medium-sized myomas and when the total number of myomas removed does not exceed 2 or 3. Gasless laparoscopic myomectomy could be mainly indicated for removal of large intramural myomas (>or=8 cm) and/or for multiple myomectomies (>or=3 myomas per patient). Anyhow, further controlled studies are needed to evaluate entirely their respective indications.
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Affiliation(s)
- Francesco Sesti
- Section of Gynecology and Obstetrics, Department of Surgery, School of Medicine, Hospital University Tor Vergata of Rome, Viale Oxford 81, 00133 Rome, Italy.
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Wang CJ, Yuen LT, Lee CL, Kay N, Soong YK. Laparoscopic myomectomy for large uterine fibroids. A comparative study. Surg Endosc 2006; 20:1427-30. [PMID: 16703432 DOI: 10.1007/s00464-005-0509-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 01/05/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The goal of this study was to examine the safety and feasibility of laparoscopic myomectomy (LM) for the management of symptomatic intramural uterine fibroids with weight greater than 80 g as compared to those less than 80 g. METHODS In a prospective comparative study, 176 women with symptomatic uterine fibroids were scheduled for LM. They were divided into two groups, one with main uterine fibroid (intramural type) weight greater than 80 g and the other with fibroid weight less than 80 g. Outcome measures for the two groups were studied in terms of operation time, amount of blood loss, requirement of blood transfusion, and length of hospital stay. RESULT Operation time and amount of blood loss were significantly greater in the group with fibroid > or = 80 g than in the group < 80 g (121.5 +/- 58.9 min versus 79.1 +/- 28.6 min, p < 0.001; and 346.3 +/- 299.6 ml versus 123.0 +/- 89.7 ml, p < 0.001, respectively). However, there was no difference in the length of hospital stay and overall incidence of operative complications between these two groups. None of the women had any major complications. Nevertheless, 11 minor complications were noted, including two pelvic abscesses requiring a second laparoscopic treatment. There was no incidence of switching to laparatomy during the operation. Extreme intraoperative hemorrhage of more than 1000 ml occurred in 8 patients; however, all progressed to full recovery after blood transfusion. Rate of blood transfusion was significantly lower in the group with fibroid < 80 g (3.2% versus 22.1%, p < 0.001). CONCLUSIONS Despite the increased operation time and blood loss, LM can be safely performed in the treatment of large uterine fibroid. However, high risk of blood transfusion in these patients has to be kept in mind.
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Affiliation(s)
- C J Wang
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, 5 Fu-Hsin Street, Kwei-Shan Tao-Yuan, 33305, Tao-Yuan, Taiwan
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Damiani A, Melgrati L, Franzoni G, Stepanyan M, Bonifacio S, Sesti F. Isobaric gasless laparoscopic myomectomy for removal of large uterine leiomyomas. Surg Endosc 2006; 20:1406-9. [PMID: 16823659 DOI: 10.1007/s00464-004-9078-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2004] [Accepted: 12/04/2004] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and safety of isobaric laparoscopic removal of large myomas (> or = 8 cm) using the Laparotenser, a subcutaneous abdominal wall-lifting system. METHODS A series of 63 consecutive patients with at least one large symptomatic subserosal or intramural uterine myoma (> or = 8 cm) underwent an isobaric gasless laparoscopic myomectomy. Conventional laparotomy instruments were used. RESULTS The procedure was successfully completed for all 63 consecutive patients. The average size of the dominant myoma was 11 cm. The mean number of myomas removed from each patient was 3.6. The mean blood loss was 143 ml, and the mean operating time was 72 min. No intraoperative complication occurred. CONCLUSIONS Gasless laparoscopic myomectomy for the removal of large myomas using the Laparotenser is feasible and safe. It offers several advantages over laparoscopy with pneumoperitoneum.
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Affiliation(s)
- A Damiani
- Division of Obstetrics and Gynecology, International School of Gynaecological Endoscopy, S. Pio X Hospital, Via F. Nava 31, 20159, Milan, Italy
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Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, Venturoli S. Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril 2006; 86:159-65. [PMID: 16764876 DOI: 10.1016/j.fertnstert.2005.11.075] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 11/23/2005] [Accepted: 11/23/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the risks and outcome of pregnancies and deliveries after laparoscopic myomectomy (LM). DESIGN Retrospective study. SETTING Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. PATIENT(S) A total of 514 patients of fertile age that underwent LM at the Center were selected. INTERVENTION(S) All the surgical procedures were performed using the same technique employing a vertical uterine incision and avoiding the use of electrosurgery. MAIN OUTCOME MEASURE(S) Number and outcome of pregnancies achieved after surgery, abortion rate, preterm delivery, gestational age, malpresentation, spontaneous or cesarean delivery, and postpartum hemorrhage. We also paid particular attention to the occurrence of uterine rupture. RESULT(S) A total of 158 pregnancies were achieved. There were 43 (27.2%) spontaneous abortions, 4 (2.6%) ectopic pregnancies, and 1 (0.6%) therapeutic abortion. Only 27 patients (25.5%) had vaginal deliveries, whereas 79 (74.5%) underwent cesarean section. No instances of uterine rupture were recorded. CONCLUSION(S) Our preliminary results confirmed that LM, performed by an expert surgeon, can restore reproductive capacity, allowing patients to have a successful pregnancy.
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Affiliation(s)
- Renato Seracchioli
- Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Laparoscopic myomectomy: feasibility and safety—a retrospective study of 762 cases. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s10397-006-0190-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liang Z, Xu H, Chen Y, Li Y, Zhang Q. Laparoscopic blockage of uterine artery and myomectomy. Surg Endosc 2006; 20:983-6. [PMID: 16738997 DOI: 10.1007/s00464-005-0643-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the effects of laparoscopic coagulation or blockage of the uterine arteries and myomectomy in treating symptomatic myomas. METHODS A total of 142 women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri were treated by laparoscopic coagulation or blocking of the uterine arteries and myomectomy. RESULTS Most of the 142 patients had multi-myomas of the uterus, as intramural myomas (54), subserous myomas (65), and submucosal myomas (25). The number of myomas in each patient varied from 1 to 4. The size of the myomas in all patients ranged from 2 to 12 cm. In 86 cases (60.4%) the uterine wall was sutured in one layer. Average operating time was 124.2 +/- 33.1 min, and average blood loss was 117.8 +/- 48.6 ml. Mean postoperative hospital stay was 4.8 +/- 1.2 days. All patients underwent technically successful laparoscopic coagulation or blocking of uterine arteries and myomectomy without intraoperative complications. The mean follow-up time was 16.2 months (16-26). Symptomatic improvement was achieved in all patients. Five patients experienced recurrence of myomas. CONCLUSIONS Laparoscopic coagulation or block of the uterine arteries and myomectomy appears to be a safe, effective, and promising new method for treating symptomatic uterine myomas.
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Affiliation(s)
- Z Liang
- Department of Obstetrics and Gynaecology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, PR China.
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