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Tinelli A, Kosmas I, Medvediev MV, Malvasi A, Morciano A, Sparić R, Mynbaev OA. Myomectomy in adult women of reproductive age: a propensity score-matched study for pregnancy rates. Arch Gynecol Obstet 2023; 308:1351-1360. [PMID: 37450263 DOI: 10.1007/s00404-023-07135-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. MATERIALS AND METHODS 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. RESULTS 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. CONCLUSION Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (Centro di RIcerca Clinico Salentino), "Veris Delli Ponti Hospital", Scorrano, Via Giuseppina Delli Ponti, 73020, Lecce, Italy.
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece
| | - Mykhailo V Medvediev
- Department of Obstetrics and Gynecology, Dnipro State Medical University, Dnipro, 49044, Ukraine
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari, Bari, Italy
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy
| | - Radmila Sparić
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ospan A Mynbaev
- Moscow Institute of Physics and Technology, 141701, Dolgoprudny, Russia
- New European Surgical Academy, Berlin, Germany
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Dumitrașcu MC, Nenciu CG, Nenciu AE, Călinoiu A, Neacșu A, Cîrstoiu M, Șandru F. Laparoscopic myomectomy - The importance of surgical techniques. Front Med (Lausanne) 2023; 10:1158264. [PMID: 37020679 PMCID: PMC10067888 DOI: 10.3389/fmed.2023.1158264] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 04/07/2023] Open
Abstract
Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.
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Affiliation(s)
- Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Cătălin-George Nenciu
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Adina-Elena Nenciu
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Amalia Călinoiu
- Department of Internal Medicine, “Prof. Dr. Agripa Ionescu” Emergency Hospital, Bucharest, Romania
| | - Adrian Neacșu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, “St. John” Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Monica Cîrstoiu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, University Emergency Hospital of Bucharest, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania
- Department of Dermatology, Elias Emergency University Hospital, Bucharest, Romania
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Hong YH, Song E, Kim SK, Lee JR, Suh CS. Operative and Obstetric Outcomes after Single-port Laparoscopic Myomectomy: A Retrospective Single-center Analysis of 504 Cases. J Minim Invasive Gynecol 2021; 28:2080-2088. [PMID: 34161855 DOI: 10.1016/j.jmig.2021.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To analyze the obstetric and operative outcomes of 504 cases of single-port laparoscopic myomectomy (SPLM). DESIGN Single-center retrospective study. SETTING A tertiary university hospital. PATIENTS A total of 502 patients (504 SPLM procedures) who underwent SPLM for symptom relief or growing myomas between October 2009 and April 2020. INTERVENTIONS Data on patient demographics, operative variables (estimated blood loss, hemoglobin decrease, operation time, perioperative complications, and postoperative hospital stay), and obstetric outcomes (the surgery-to-pregnancy interval and birth-related outcomes) were obtained from medical records and analyzed. MEASUREMENTS AND MAIN RESULTS The mean age of the patients was 40.6 ± 6.6 years. The patients had had an average of 2.3 ± 2.2 myomas removed; the largest myoma size was 6.8 ± 2.4 cm. The mean operation time, postoperative hemoglobin decrease, and postoperative hospital stay duration were 112.9 ± 45.3 minutes, 1.7 ± 1.1 g/dL, and 2.2 ± 1.4 days, respectively. The overall rate of postoperative complications was 7.7% (39/504), and the common complications were transfusions (16/504, 3.1%) or wound problems (15/504, 3.0%). Conversion to multiport or open myomectomy was required in 0.8% of the cases (4/504). A total of 376 women were of child-bearing age, and 56 attempted to become pregnant after surgery. The mean interval from surgery to pregnancy was 15.6 ± 12.2 months. The obstetric outcomes were pregnancy (42/56, 75.0%), live birth (39/56, 69.6%), and miscarriage (2/56, 3.6%). One pregnant woman was lost to follow-up. The 39 live births predominantly involved full-term delivery (36/39, 92.3%), mostly through cesarean section (36/39, 92.3%). No postpartum complications were reported. The 2 most common obstetric complications were preterm labor (7.6%) and gestational diabetes (5.1%). CONCLUSION SPLM seems to be an effective procedure with good operative and postoperative obstetric outcomes for women with myomas who require surgery and may wish to subsequently become pregnant.
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Affiliation(s)
- Yeon Hee Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea
| | - Eunjin Song
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, (Drs. Hong, Song, Kim, and Lee), Seongnam, South Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine (Drs. Hong, Kim, Lee, and Suh), Seoul, South Korea; Department of Surgical Oncology, Sheikh Khalifa Specialty Hospital (Dr. Suh), Ras Al Khaimah, United Arab Emirates
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Prapas Y, Zikopoulos A, Petousis S, Xiromeritis P, Tinelli A, Ravanos K, Margioula-Siarkou C, Chalkia-Prapa EM, Prapas N. Single layer suturing in intracapsular myomectomy of intramural myomas is sufficient for a normal wound healing. Eur J Obstet Gynecol Reprod Biol 2020; 248:204-210. [PMID: 32283430 DOI: 10.1016/j.ejogrb.2020.03.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To evaluate surgical outcomes of intracapsular single-layer myomectomy in terms of efficacy and safety as well as examine potential alterations based on kind of surgical approach. METHODS A prospective observational study was performed between January 2010 and December 2018. Women in reproductive age, affected by intramural or subserous myomas (FIGO type 3-6) of 4-14 cm diameter were enrolled. Primary outcomes included initial and final uterine incision length, time to wound healing and uterine rupture in subsequent pregnancies. Furthermore, a sub-analysis was also performed regarding surgical approach, namely laparoscopical or laparoscopically-assisted myomectomy, in order to confirm whether overall observations are similar for both potential surgical approaches. RESULTS There were finally 273 patients included in the present study. Overall mean uterine incision was initially 3.1 cm and was shortened to 2.2 cm at the end of operation, indicating a reduction of 29.1 %. Mean estimated blood loss was 154.2 mL and mean operative time was 82.1 min. No severe intraoperative and postoperative complications were presented. 121 of the studied women had pregnancy 3-36 months after myomectomy, without reporting any uterine rupture. When comparing LIM vs. LAIM, all outcomes were also favorable in the total of patients. CONCLUSION Intracapsular myomectomy either by LIM or LAIM is a safe and attractive alternative to abdominal myomectomy in setting of premenopausal patients with myomas up to 14 cm. A single-layer continuous suturing in intracapsular myomectomies is enough for a successful wound healing.
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Affiliation(s)
- Yannis Prapas
- IAKENTRO, Infertility Treatment Center, Thessaloniki, Greece
| | - Athanasios Zikopoulos
- Department of Obstetrics and Gynaecology, Medical School, University of Ioannina, Greece
| | - Stamatios Petousis
- IAKENTRO, Infertility Treatment Center, Thessaloniki, Greece; 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece.
| | | | - Andrea Tinelli
- Division of Experimental Researches on Endoscopic Surgery, Imaging, Minimally Invasive Technology, Department of Obstetric & Gynecology, Vito Fazzi Hospital, Lecce, Italy
| | | | - Chrysoula Margioula-Siarkou
- IAKENTRO, Infertility Treatment Center, Thessaloniki, Greece; 2nd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece
| | | | - Nikos Prapas
- IAKENTRO, Infertility Treatment Center, Thessaloniki, Greece
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Sheu BC, Huang KJ, Huang SC, Chang WC. Comparison of uterine scarring between robot-assisted laparoscopic myomectomy and conventional laparoscopic myomectomy. J OBSTET GYNAECOL 2019; 40:974-980. [PMID: 31790613 DOI: 10.1080/01443615.2019.1678015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study compared uterine wound healing after robot-assisted laparoscopic myomectomy (RM) and laparoscopic myomectomy (LM). Ultrasound was used to evaluate the scar repair of uterine wounds at 1, 3, and 6 months postoperatively. Ninety-three RM and 110 LM patients were enrolled. More myomas excised using RM were type 1∼type 3(51.1%) and more myomas excised using LM were type 4∼type 6(54.2%), p < .001. Both groups had myomas of similar size (RM vs. LM, 9.0 vs. 8.4 cm, p = .115) and weight (RM vs. LM, 322 vs. 274 g, p = .102). The mean myoma number was significantly larger in RM patients than LM patients (RM vs. LM, 3.3 vs. 1.8, p < .001). Significantly more patients were found to have haematomas in the LM than the RM group (RM vs. LM, 0 vs. 6, p = .032); two in type 3, two in type 4 and two in type 8 myomas. Four small haematomas spontaneously resolved at the 3rd month, and a large one resolved at the 9th month postoperatively. One haematoma caused pelvic infection and a 7-cm peritoneal inclusion cyst during sonographic follow up. RM resulted in fewer postoperative haematomas and may result in superior uterine repair relative to LM after excision of symptomatic type 3, type 4 and type 8 myomas. RM is suggested for these patients, especially those considering future pregnancy.IMPACT STATEMENTWhat is already known on this subject? Reconstructive suturing and uterine wound healing are the main challenges when performing laparoscopic myomectomy (LM), and spontaneous uterine rupture during pregnancy following LM has been reported because of its limitations in multilayer closure of the myoma bed. Robot-assisted laparoscopic myomectomy (RM) has improved visualisation and EndoWrist movements resulted in adequate multilayered suturing, which may overcome the technical limitations of reconstructive suturing in conventional LM.What do the results of this study add? We evaluated postoperative uterine scarring after RM and LM using ultrasound and found RM resulted in fewer postoperative haematomas, which result in superior uterine wound repair, relative to LM after excision of symptomatic type 3, type 4 and type 8 myomas.What are the implications of these findings for clinical practice and/or further research? RM is suggested for symptomatic type 3, type 4 and type 8 myomas because of superior uterine wound repair, especially those considering future pregnancy.
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Affiliation(s)
- Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Ju Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Su-Cheng Huang
- Department of Obstetrics and Gynecology, Buddhist Tzu-Chi General Hospital, Taipei Branch, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
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Kameda S, Toyoshima M, Tanaka K, Fujii O, Iida SI, Yaegashi N, Murakami T, Hoshi K. Utility of Laparoscopic Uterine Myomectomy as a Treatment for Infertility with No Obvious Cause Except for Uterine Fibroids. Gynecol Minim Invasive Ther 2018; 7:152-155. [PMID: 30306033 PMCID: PMC6172875 DOI: 10.4103/gmit.gmit_2_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/24/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives: Uterine fibroids are capable of causing infertility, but there are no definite criteria for which laparoscopic uterine myomectomy (LM) is known to be beneficial. To investigate the usefulness of LM, we examined pregnancy rates in patients with infertility with no obvious cause except for the presence of uterine fibroids. Materials and Methods: We retrospectively reviewed the clinical records at Suzuki Memorial Hospital between June 2010 and August 2014. We found 60 eligible patients (LM group, 46; non-LM group, 14). The criteria for performing LM were a maximal fibroid diameter of 40 mm or more or the presence of >4 fibroids. Results: The duration of infertility before the first visit was significantly longer in the LM group; although there was no significant difference in the mean patient age and body mass index. Pregnancy was achieved in 45.7% of patients (21/46) in the LM group and 28.6% (4/14) in the non-LM group. There were no pregnancies in patients with >10 fibroids. The postoperative pregnancy rate in the LM group was comparable to previously reported pregnancy rates. Conclusions: Our criteria for performing LM in patients with no obvious cause for infertility except for uterine fibroids seem appropriate, especially when the fibroids are large and the number of fibroids is between 4 and 9. However, our results suggest that the effectiveness of LM is low in patients with 10 or more uterine fibroids.
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Affiliation(s)
- Satomi Kameda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Masafumi Toyoshima
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kohei Tanaka
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Osamu Fujii
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Shu-Ichi Iida
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Shiga, Japan
| | - Kazuhiko Hoshi
- Department of Obstetrics and Gynecology, Suzuki Memorial Hospital, Iwanuma, Miyagi, Japan
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Fujimoto A, Morimoto C, Hosokawa Y, Hasegawa A. Suturing method as a factor for uterine vascularity after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2017; 211:146-149. [PMID: 28260688 DOI: 10.1016/j.ejogrb.2017.02.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/25/2017] [Accepted: 02/26/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the vascularity of the myometrium after laparoscopic myomectomy sutured by two different methods using contrast-enhanced Magnetic Resonance Imaging. STUDY DESIGN Twenty-eight women who had symptomatic leiomyomas and underwent laparoscopic myomectomy between June 2013 and July 2014 were included in the present study. In the first half period, continuous sutures were used in 12 patients, and in the latter half period, single interrupted sutures were used in 16 patients. Contrast-enhanced Magnetic Resonance Imaging was used 3 or 6 months after surgery to evaluate vascularity after laparoscopic myomectomy. We defined avascularity index as the percentage of avascular area after surgery to cross sectional area of myoma before surgery. The Wilcoxon rank-sum test was applied to compare avascularity indeces in the two study groups. RESULTS At 3 months after surgery, avascularity index in continuous sutures group was significantly higher than that in single interrupted sutures group (median 5.0 vs.1.2, p<0.001), suggesting a poorer vascular recovery of the myometrium sutured continuously. CONCLUSION Simple interrupted suturing might be superior to continuous suturing in terms of vascularity evaluated using contrast enhanced Magnetic Resonance Imaging.
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Affiliation(s)
- Akihisa Fujimoto
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan.
| | - Chieko Morimoto
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
| | - Yumi Hosokawa
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
| | - Akiko Hasegawa
- Department of Obstetrics and Gynecology, Sanraku Hospital, Tokyo, Japan
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Leone Roberti Maggiore U, Scala C, Venturini PL, Ferrero S. Preoperative treatment with letrozole in patients undergoing laparoscopic myomectomy of large uterine myomas: a prospective non-randomized study. Eur J Obstet Gynecol Reprod Biol 2014; 181:157-62. [DOI: 10.1016/j.ejogrb.2014.07.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/23/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
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Zhang Y, Hua KQ. Patients' age, myoma size, myoma location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy. J Laparoendosc Adv Surg Tech A 2013; 24:95-9. [PMID: 24368007 DOI: 10.1089/lap.2013.0490] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate which clinical characteristics will influence the pregnancy rate and live birth rate after myomectomy. SUBJECTS AND METHODS Data of clinical characteristics and reproductive outcome from 471 patients who wished to conceive and who underwent abdominal or laparoscopic myomectomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2008 to June 2012 were retrospectively analyzed. RESULTS Average age in the pregnancy group (30.0±3.7 years) and the nonpregnancy group (31.2±4.1 years) was statistically different (P=.000). The diameter of the biggest myoma had a positive relationship with the pregnancy rate when it was <10 cm (rs=0.095, P=.039). Abortions before myomectomy, operation type, number, location, and classification of myomas, uterine cavity penetration, and uterine volume seemed not to influence the pregnancy rate (P>.05). The location of the myoma may influence the live birth rate after myomectomy (rs=0.198, P=.002). Anterior and posterior myomas were associated with higher live birth rates than other locations (P=.001). The average interval between myomectomy and pregnancy was 16.0±8.7 months, and there was no difference between the abdominal (17.2±8.6 months) and laparoscopic (15.2±8.8 months) groups (P=.102). The interval in the live birth group was 15.0±8.4 months, and that in the non-live birth group was 18.9±9.3 months; the difference was significant (P=.005). CONCLUSIONS Patients' age, myoma size and location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy.
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Affiliation(s)
- Ying Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University , Shanghai, People's Republic of China
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Yang JH, Chen MJ, Chen CD, Chen SU, Ho HN, Yang YS. Optimal waiting period for subsequent fertility treatment after various hysteroscopic surgeries. Fertil Steril 2013; 99:2092-6.e3. [PMID: 23433831 DOI: 10.1016/j.fertnstert.2013.01.137] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/24/2013] [Accepted: 01/24/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the endometrial wound healing duration after a hysteroscopic surgery. DESIGN Prospective study. SETTING Tertiary university hospital. PATIENT(S) One hundred sixty-three women who underwent hysteroscopic surgeries for endometrial polyp (n = 37), submucous myoma (n = 65), uterine septum (n = 16), and intrauterine adhesion (IUA; n = 45). INTERVENTION(S) Postoperative office hysteroscopy was consecutively done until complete endometrial wound healing. If there was newly formed IUA occurring at the endometrial wounds, adhesiolysis was immediately done with the tip of the office hysteroscope. MAIN OUTCOME MEASURE(S) Office hysteroscopic inspection of endometrial wound healing and the presence of newly formed IUA. RESULT(S) Thirty-two of 37 women (86%) achieved a fully healed endometrium 1 month after polypectomy, a higher rate than those after myomectomy (18%), septal incision (19%), and adhesiolysis (67%). Postoperative office hysteroscopy revealed that 88% and 76% of the women had new IUA formation after septal incision and adhesiolysis, respectively, more than those after myomectomy (40%) and polypectomy (0%). Women with postoperative new IUA formation were less likely to achieve endometrial wound healing within 1 month compared with those who had no new IUA formation (31% vs. 61%). CONCLUSION(S) The duration of endometrial wound healing is different after various hysteroscopic surgeries. Postoperative new IUA formation is an important factor influencing endometrial wound healing.
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Affiliation(s)
- Jehn-Hsiahn Yang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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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: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Robot-assisted laparoscopic myomectomy and adenomyomectomy with a flexible CO2 laser device. J Robot Surg 2012; 7:157-62. [DOI: 10.1007/s11701-012-0360-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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Awonuga AO, Fletcher NM, Saed GM, Diamond MP. Postoperative adhesion development following cesarean and open intra-abdominal gynecological operations: a review. Reprod Sci 2011; 18:1166-85. [PMID: 21775773 DOI: 10.1177/1933719111414206] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.
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Affiliation(s)
- Awoniyi O Awonuga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Parker WH, Einarsson J, Istre O, Dubuisson JB. Risk Factors for Uterine Rupture after Laparoscopic Myomectomy. J Minim Invasive Gynecol 2010; 17:551-4. [DOI: 10.1016/j.jmig.2010.04.015] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 04/25/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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15
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Preliminary uterine artery ligation versus pericervical mechanical tourniquet in reducing hemorrhage during abdominal myomectomy. Int J Gynaecol Obstet 2009; 108:233-5. [DOI: 10.1016/j.ijgo.2009.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 08/24/2009] [Accepted: 10/21/2009] [Indexed: 11/21/2022]
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16
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Chang WC, Chang DY, Huang SC, Shih JC, Hsu WC, Chen SY, Sheu BC. Use of three-dimensional ultrasonography in the evaluation of uterine perfusion and healing after laparoscopic myomectomy. Fertil Steril 2009; 92:1110-1115. [DOI: 10.1016/j.fertnstert.2008.07.1771] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 07/25/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
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17
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Postmyomectomy sonographic imaging: uterus remodeling and scar repair. Arch Gynecol Obstet 2009; 280:509-11. [DOI: 10.1007/s00404-009-0967-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/27/2009] [Indexed: 11/26/2022]
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