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The effect of temporary uterine artery ligation on laparoscopic myomectomy to reduce intraoperative blood loss: A retrospective case–control study. Eur J Obstet Gynecol Reprod Biol X 2022; 15:100162. [PMID: 36035234 PMCID: PMC9399157 DOI: 10.1016/j.eurox.2022.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/22/2022] [Accepted: 08/06/2022] [Indexed: 11/20/2022] Open
Abstract
Objective Study Design Results Conclusions The surgical technique for laparoscopic myomectomy is introduced. Temporary uterine artery ligation decreases the volume of intraoperative blood loss. Temporary uterine artery ligation is less invasive than permanent occlusion. Temporary uterine artery ligation does not require the use of any special devices, such as clips.
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Torng PL, Pan SP, Hsu HC, Chen IH, Hwang JS. GnRHa Before Single-Port Laparoscopic Hysterectomy in a Large Barrel-Shaped Uterus. JSLS 2019; 23:JSLS.2019.00019. [PMID: 31341378 PMCID: PMC6634953 DOI: 10.4293/jsls.2019.00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background and Objectives: Laparoscopic hysterectomy for a large barrel-shaped uterus is difficult. We assessed the feasibility of single-port laparoscopic hysterectomy in a large barrel-shaped uterus after gonadotropin-releasing hormone agonist (GnRHa). Methods: We retrospectively reviewed 39 patients with a large barrel-shaped uterus who were treated with GnRHa (leuprolide acetate) before single-port laparoscopic hysterectomy. During the same period, 134 patients without GnRHa pretreatment were included as control subjects. Results: Patients with GnRHa treatment had an average increase in hemoglobin of 3.0 mg/dL and a decrease in uterine weight of 330.9 g (40.1%). Ancillary ports were required in 2 patients in the treatment group and none in the control group. There were no differences in uterine weights, operative time, and estimated blood loss in the 2 groups of patients. The estimated average operative time was shortened by 34 min after GnRHa treatment. However, bladder and ureter injuries were marginally higher (10.3% versus 2.2%) and days of hospital stay (3.7 versus 3.1) were significantly longer in the treatment group compared with controls. Complication rates were correlated with previous operative history, pelvic adhesion, and larger uterine weight but not with GnRHa treatment and operative sequence. Conclusions: GnRHa pretreatment in patients with a large barrel-shaped uterus during SPH is feasible with shortened operative time. However, the higher complication rates in these patients suggest that a weight-reduced barrel-shaped uterus that is achieved with GnRHa treatment could still be difficult and should be handled in cautious.
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Affiliation(s)
- Pao-Ling Torng
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Song-Po Pan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - I-Hui Chen
- Department of Obstetrics and Gynecology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu, Taiwan
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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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Predictors of postoperative hemoglobin drop after laparoscopic myomectomy. Wideochir Inne Tech Maloinwazyjne 2017; 12:81-87. [PMID: 28446936 PMCID: PMC5397549 DOI: 10.5114/wiitm.2017.66515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/01/2017] [Indexed: 02/06/2023] Open
Abstract
Introduction Laparoscopic myomectomy (LM) can be associated with significant bleeding. Aim To identify factors influencing the postoperative hemoglobin (Hb) drop after LM. Material and methods This is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015. Results The median age of the patients was 37 (23–53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5–12) cm. The mean surgical time was 83 ±38 (35–299) min. The median number of sutures was 3 (1–11). The mean postoperative Hb drop was 1.6 ±1.2 (0–6) g/dl, and the mean estimated blood loss was 261 ±159 (50–1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients’ age or number of intramural myomas. In the multivariable analysis, the surgical time (β = 0.395, p < 0.001), diameter of the largest myoma (β = 0.292, p = 0.03) and preoperative Hb concentration (β = 0.299, p < 0.001) predicted the postoperative Hb change. Conclusions Surgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.
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Minispectrometer with handheld probe for 5-ALA based fluorescence-guided surgery of brain tumors: Preliminary study for clinical applications. Photodiagnosis Photodyn Ther 2017; 17:147-153. [DOI: 10.1016/j.pdpdt.2016.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 12/07/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022]
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Luangkesorn K, Eren-Doğu Z. Markov Chain Monte Carlo methods for estimating surgery duration. J STAT COMPUT SIM 2015. [DOI: 10.1080/00949655.2015.1004065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tinelli A, Mynbaev OA, Mettler L, Hurst BS, Pellegrino M, Nicolardi G, Kosmas I, Malvasi A. A combined ultrasound and histologic approach for analysis of uterine fibroid pseudocapsule thickness. Reprod Sci 2014; 21:1177-86. [PMID: 24879045 DOI: 10.1177/1933719114537719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Authors investigated 75 patients with uterine myomas, appraising whether fibroid pseudocapsule (FP) thickness varies depending on fibroid location, by a prospective cohort trial (level of evidence II-2) settled in University-affiliated Hospitals. Uteri were scanned via bidimensional and power Doppler ultrasound (US) to map the fibroids and record the FP thickness, prior to hysterectomy for symptomatic uterine fibroids. After hysterectomy, FP specimens were sampled and analyzed by pathologists. Ultrasound and histology data were matched. Pseudocapsule thickness of 108 fibroids was measured: subserosal fibroids (SSFs), intramural fibroids (IMFs), and fibroids near the endometrial cavity (FEC). The FEC's pseudocapsules were considerably thicker than those of IMF and SSF measured by US and histology (P = .001). A clear cutoff existed between FEC pseudocapsule thickness and all other pseudocapsules, with significant differences observed at 2 mm (P = .001). Similarity between histological and US measurements was observed only with IMF pseudocapsules, whereas FEC or SSF showed significant differences. The pseudocapsule of fibroids is considerably thicker near the endometrial cavity when compared to those of both IMFs and SSFs. Since fibroids closest to the endometrial cavity are the most involved in fertility and infertility and FP is considerably thicker near the endometrial cavity, it is possible to hypothesize an involvement of FP of fibroid near the endometrium since FP contains many neuropeptides and neurotransmitters that are physiologically active, even if these data may take on a broader meaning in a study on a larger number of patients.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
| | - Ospan A Mynbaev
- Moscow Institute of Physics & Technology, State University, Moscow, Russia Laboratory of pilot projects Moscow State University of Medicine & Dentistry, Moscow, Russia Department of ObGyn and Reproductive Medicine, Peoples' Friendship University of Russia, Moscow, Russia
| | - Liselotte Mettler
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University, Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Brad S Hurst
- Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Giuseppe Nicolardi
- Human Anatomy and Neuroscience Unit, University of Salento, Lecce, Italy
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece
| | - Antonio Malvasi
- Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy
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Tinelli A, Mettler L, Malvasi A, Hurst B, Catherino W, Mynbaev OA, Guido M, Alkatout I, Schollmeyer T. Impact of surgical approach on blood loss during intracapsular myomectomy. MINIM INVASIV THER 2013; 23:87-95. [DOI: 10.3109/13645706.2013.839951] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Di Tommaso S, Massari S, Malvasi A, Bozzetti MP, Tinelli A. Gene expression analysis reveals an angiogenic profile in uterine leiomyoma pseudocapsule. Mol Hum Reprod 2013; 19:380-7. [PMID: 23355533 DOI: 10.1093/molehr/gat007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The pseudocapsule (PC) of the uterine leiomyoma (UL) is an anatomic entity that surrounds the myoma separating it from the myometrium (UM). Although a number of microarray experiments have identified differences in gene expression profile in the UL when compared with the UM, there is a lack of systematic studies on the PC. In this study, quantitative RT-PCR analysis was performed on 18 matched PC, UL and UM specimens and results showed that the PC displays a specific gene expression profile. The low expression level of insulin-like growth factor (IGF-2), a fibroid specific marker, that we found in the PC and the UM when compared with the UL, clearly indicates that the PC is in structural continuity with the UM. However, the significant increase in endoglin expression level in PC with respect to the UL and UM indicates that an active neoangiogenesis is present in PC. Conversely, other angiogenic factors such as von Willebrand factor (vWF) and vascular endothelial growth factor A (VEGF-A) seem to have little influence on the PC angiogenesis. Because the endoglin is preferentially expressed in proliferating endothelial cells, whereas the vWF and VEGF-A are preferentially expressed in preexisting endothelial cells, our idea is that the angiogenic activity in the PC is linked to wound healing. The angiogenic activity is also sustained by intermediate expression level of cystein-rich angiogenesis inducer 61, connective tissue growth factor and collagen 4α2 genes all involved in the neoangiogenesis, that we detected in the PC. Taken together our data demonstrate that the specific expression pattern observed in the PC could be the response of the uterine wall's smooth cells to the tension imposed by the tumor. As a consequence, a neovascular structure is generated involving regenerative processes. For these reasons, we suggest that the laparoscopic intracapsular myomectomy (LIM), a new surgical technique that preserves the PC during the UL removal, should always be preferred, to favor a faster and proper uterine healing.
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Affiliation(s)
- S Di Tommaso
- Department of Biological and Environmental Sciences and Technologies, University of Salento, 73100 Lecce, Italy.
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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: 12] [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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Tinelli A, Malvasi A, Hurst BS, Tsin DA, Davila F, Dominguez G, Dell'edera D, Cavallotti C, Negro R, Gustapane S, Teigland CM, Mettler L. Surgical management of neurovascular bundle in uterine fibroid pseudocapsule. JSLS 2012; 16:119-29. [PMID: 22906340 PMCID: PMC3407432 DOI: 10.4293/108680812x13291597716302] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate. The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids, including pain, infertility, and reproductive outcomes.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy.
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Mettler L, Tinelli A, Hurst BS, Teigland CM, Sammur W, Dell'edera D, Negro R, Gustapane S, Malvasi A. Neurovascular bundle in fibroid pseudocapsule and its neuroendocrinologic implications. Expert Rev Endocrinol Metab 2011; 6:715-722. [PMID: 30780878 DOI: 10.1586/eem.11.62] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The myoma pseudocapsule is a surgical-anatomical entity surrounding the fibroid that separates the myoma from normal uterine tissue. The myoma pseudocapsule has a delicate vascular network rich with neurotransmitters analogous to the neurovascular bundle surrounding the prostate. The pseudocapsule neurovascular bundle is extremely important during myomectomy to promote uterine myometrial healing and, consequently, for uterine reproductive function. New advancements in surgery, including the use of laparoscopic myomectomy by an intracapsular technique and magnification of the myoma pseudocapsule to enhance visualization are comparable to the dissection during a radical prostatectomy. Fibroid detachment occurring inside the pseudocapsule causes less bleeding, spares the neurovascular bundle and promotes better uterine healing. The maintenance of myometrial integrity after laparoscopic myomectomy maintains uterine function and therefore improves reproductive outcomes, including labor.
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Affiliation(s)
- Liselotte Mettler
- a Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynaecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Andrea Tinelli
- b Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy.
| | - Brad S Hurst
- c Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC 28203, USA
| | - Chris M Teigland
- d Department of Urology, Carolinas Medical Center, Charlotte, NC 28203, USA
- e Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA
| | - Wael Sammur
- f Department of Obstetrics and Gynecology, German Medical Centre, DHCC, Dubai, United Arab Emirates
| | - Domenico Dell'edera
- g Unit of Cytogenetic and Molecular Genetics, Madonna delle Grazie Hospital, Matera, Italy
| | - Roberto Negro
- h Department of Endocrinology, Vito Fazzi Hospital, Lecce, Italy
| | - Sara Gustapane
- i Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, Italy
| | - Antonio Malvasi
- j Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
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Chang WC, Chou LY, Chang DY, Huang PS, Huang SC, Chen SY, Sheu BC. Simultaneous laparoscopic uterine artery ligation and laparoscopic myomectomy for symptomatic uterine myomas with and without in situ morcellation. Hum Reprod 2011; 26:1735-40. [DOI: 10.1093/humrep/der142] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tinelli A, Malvasi A, Hudelist G, Cavallotti C, Tsin DA, Schollmeyer T, Bojahr B, Mettler L. Laparoscopic Intracapsular Myomectomy: Comparison of Single Versus Multiple Fibroids Removal. An Institutional Experience. J Laparoendosc Adv Surg Tech A 2010; 20:705-11. [DOI: 10.1089/lap.2010.0082] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Tinelli
- Division of Experimental Endoscopic Surgery, Imaging, and Minimally Invasive Therapy and Technology, Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Gernot Hudelist
- Department of Obstetrics and Gynaecology, LKH Villach, Villach, Austria
| | - Carlo Cavallotti
- Section of Anatomy, Department of Cardiovascular and Respiratory Sciences, University “La Sapienza,” Rome, Italy
| | - Daniel Alberto Tsin
- Division of Minimal Invasive Endoscopy, Department of Gynecology, The Mount Sinai Hospital of Queens, Long Island City, New York
| | - Thoralf Schollmeyer
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Bernd Bojahr
- Department of Gynaecology, MIC Clinic at Ev. Krankenhaushaus St. Hubertus, Berlin, Germany
| | - Liselotte Mettler
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
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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: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tinelli A, Malvasi A, Rahimi S, Negro R, Cavallotti C, Vergara D, Vittori G, Mettler L. Myoma pseudocapsule: a distinct endocrino-anatomical entity in gynecological surgery. Gynecol Endocrinol 2009; 25:661-7. [PMID: 19526398 DOI: 10.1080/09513590903015502] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of detailed information concerning myoma pseudocapsule, the author reviewed this important topic. METHODS An extensive literature review from 1980 to 2008 was performed on the myoma pseudocapsule, using: fibroid, myoma, myomectomy and reproductive outcome, as keywords. RESULTS The fibroid removal should always be performed inside its pseudocapsule and with a careful stretching, to extract fibroid from the surrounding fibromuscular skeleton, breaking up the fibrous bridges; because the vascular network generally surrounds the myoma, detachment of the myoma occurring inside the pseudocapsule should cause less bleeding. The maintenance of myometrial integrity during myomectomy allows the facilitation of uterine healing and is of benefit for future reproductive outcome. CONCLUSION The benefits of intracapsular myomectomy are evident, because it preserves myometrial integrity and allows for restoration of the uterine musculature. This correct myomectomy, if done by laparoscopy, confers significant advantages in less intraoperative blood loss, short duration of hospital stay, few therapeutic antibiotic administration and better future fertility.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, Lecce 73100, Italy.
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Chang WC, Huang SC, Sheu BC, Shih JC, Hsu WC, Chen SY, Chang DY. Changes in uterine blood flow following laparoscopic myomectomy with or without uterine artery ligation on two- and three-dimensional power Doppler ultrasound. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:221-227. [PMID: 19086039 DOI: 10.1002/uog.6225] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate differences in uterine perfusion following laparoscopic myomectomy with or without uterine artery ligation (UAL). METHODS From November 2005 to July 2007, we enrolled prospectively 105 women with symptomatic myomas who were scheduled to undergo laparoscopic myomectomy (57 with UAL (study group) and 48 without (control group)). Power Doppler ultrasound was used to evaluate uterine artery resistance (RI) and pulsatility (PI) indices and peak systolic velocity (PSV) and three-dimensional (3D) power Doppler ultrasound was used to obtain vascularization (VI), flow (FI) and vascularization flow (VFI) indices of the uterine tissue, which were calculated by VOCAL (Virtual Organ Computer-aided AnaLysis) software. RESULTS Characteristics of the myomas, operative time and duration of hospital stay were comparable between the two groups, whereas the median (range) of estimated blood loss (50 (50-200) vs. 100 (50-900) mL, P = 0.001) and the frequency of excessive bleeding of > 500 mL (0% vs. 10%, P = 0.018) were significantly lower in the study group. The RI, PI and PSV were comparable between the two groups preoperatively, significantly lower in the study group 1 week after surgery (0.69 vs. 0.74, 1.31 vs. 1.76, and 34.08 vs. 47.49, respectively, P < 0.05), and comparable again 3 months later. The myometrial VI and VFI decreased after surgery and all three 3D power Doppler indices of the study group were similar to those of the control group throughout the study period. CONCLUSION Concurrent UAL during laparoscopic myom- ectomy reduces the intraoperative blood loss and frequency of excessive bleeding without permanently compromising uterine perfusion.
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Affiliation(s)
- W-C Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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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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