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Lee N, Choi SH, Won S, Jung YW, Kim SH, Lee JY, Lim CK, Yang JB, Ha JG, Seong SJ. Comparison of Surgical Outcomes of Two New Techniques Complementing Robotic Single-Site Myomectomy: Coaxial Robotic Single-Site Myomectomy vs. Hybrid Robotic Single-Site Myomectomy. J Pers Med 2024; 14:439. [PMID: 38673066 PMCID: PMC11050827 DOI: 10.3390/jpm14040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to compare surgical outcomes between two new robotic single-site myomectomy (RSSM)-complementary techniques: coaxial robotic single-site myomectomy (Coaxial-RSSM) and hybrid robotic single-site myomectomy (Hybrid-RSSM). METHODS Medical records for 132 women undergoing Coaxial-RSSM and 150 undergoing Hybrid-RSSM, consecutively, were retrospectively reviewed. Patient characteristics and surgical outcomes were assessed and compared after propensity score matching (PSM). RESULTS In the outcomes of PSM, the Coaxial-RSSM group showed significantly reduced blood loss (79.71 vs. 163.75 mL, p < 0.001) and reduced hospital duration (4.18 ± 0.62 vs. 4.63 ± 0.90) relative to the Hybrid-RSSM group. Conversely, Hybrid-RSSM allowed for a shorter operative time compared with Coaxial-RSSM (119.19 vs. 156.01 min, p = 0.007). No conversions to conventional laparoscopy or laparotomy or any need for the multi-site robotic approach occurred in either group. Postoperative complications, including ileus, fever, and wound dehiscence, showed no statistically significant differences between the two groups. CONCLUSIONS Blood loss was lower with Coaxial-RSSM, and operative time was shorter for Hybrid-RSSM. A follow-up prospective study is warranted for more comprehensive comparison of surgical outcomes between the two techniques.
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Affiliation(s)
- Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Su-Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Yong-Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seung-Hyun Kim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jin-Yu Lee
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Chul-Kwon Lim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jung-Bo Yang
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Joong-Gyu Ha
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Seok-Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
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Pirtea L. Editorial: Minimally invasive surgery in benign gynecological pathology. Front Med (Lausanne) 2024; 11:1379505. [PMID: 38455475 PMCID: PMC10918588 DOI: 10.3389/fmed.2024.1379505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Laurentiu Pirtea
- Department of Obstetrics and Gynaecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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Ren HM, Wang QZ, Wang JN, Hong GJ, Zhou S, Zhu JY, Li SJ. Diffuse uterine leiomyomatosis: A case report and review of literature. World J Clin Cases 2022; 10:8797-8804. [PMID: 36157811 PMCID: PMC9453368 DOI: 10.12998/wjcc.v10.i24.8797] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/24/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Diffuse uterine leiomyomatosis (DUL) is a benign uterine smooth muscle neoplasm with unknown etiology. Since DUL is rarely reported, knowledge regarding it is limited. The rate of early diagnosis is low, and DUL is often misdiagnosed as common multiple uterine leiomyomas before surgery.
CASE SUMMARY A 27-year-old patient with no sexual activity presented to the Emergency Department of our hospital complaining of heavy vaginal bleeding. She had a history of uterine fibroids and menorrhagia. Pelvic examination showed a regularly enlarged uterus, similar in size to that associated with a 4-mo pregnancy. Pelvic magnetic resonance imaging (MRI) revealed numerous multiple uterine fibroids, and a transabdominal myomectomy (TM) was performed. Intraoperative exploration revealed that the myometrium was full of myoma nodules of variable sizes. Over 50 leiomyomas were removed. The pathology report confirmed leiomyoma. The patient was discharged and received a gonadotropin-releasing hormone analog (3.75 mg) for 6 mo. Ten months after surgery, the patient presented to the hospital again for abnormal uterine bleeding. MRI showed an irregular mass with a diameter of 5.2 cm without sharp demarcation in the uterine cavity. Submucosal leiomyoma was considered first, and the patient underwent a hysteroscopic myomectomy plus hymen repair. Intraoperative exploration showed that there were several leiomyomatosis masses in the cavity. Postoperative pathological examination confirmed submucosal leiomyoma and necrotic and generative tissue. Although the menstrual cycle was still irregular, the patient did not have symptoms of menorrhagia for a period of 28 mo after the second surgery.
CONCLUSION Individuals with DUL are easily misdiagnosed due to the lack of specific manifestations of this disease. MRI is helpful for early identification and preoperative evaluation. There is currently no unified method of diagnosis. For women who want to preserve fertility, conservative surgery should be made an option. When TM is chosen, a modified new myomectomy should be considered to avoid the drawbacks of traditional TM.
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Affiliation(s)
- Hui-Min Ren
- Department of Gynecology, Zhoushan Branch Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Zhoushan 316000, Zhejiang Province, China
| | - Qing-Zhu Wang
- Department of Obstetrics and Gynecology, Ningbo Hangzhou Bay Hospital, Ningbo 315336, Zhejiang Province, China
| | - Jia-Nan Wang
- Department of Pathology, Zhoushan Branch Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Zhoushan 316000, Zhejiang Province, China
| | - Gang-Jie Hong
- Department of Gynecology, Zhoushan Branch Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Zhoushan 316000, Zhejiang Province, China
| | - Shuang Zhou
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200090, China
| | - Jun-Yan Zhu
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
| | - Shan-Ji Li
- Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
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Don EE, Mijatovic V, van Eekelen R, Huirne JA. The effect of myomectomy on reproductive outcomes in patients with uterine fibroids: A retrospective cohort study. Reprod Biomed Online 2022; 45:970-978. [DOI: 10.1016/j.rbmo.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/18/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
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Gao H, Li T, Fu D, Wei J. Uterine artery embolization, surgery and high intensity focused ultrasound in the treatment of uterine fibroids: a network meta-analysis. Quant Imaging Med Surg 2021; 11:4125-4136. [PMID: 34476193 DOI: 10.21037/qims-20-1331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/02/2021] [Indexed: 12/28/2022]
Abstract
Background To systematic review the safety and effectiveness between uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Data, and CNKI were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. After two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 and Stata 14 software. Results A total of 11 studies (22 articles) involving 3,646 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis show that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and the highest surgery. Patients treated with HIFU and UAE have shorter hospital stays and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU. Conclusions UAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risks of re-treatment. However, limited by the number and quality of included studies, the above conclusions need to be verified through more high-quality studies.
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Affiliation(s)
- Haijun Gao
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Tianping Li
- General Department, Chongqing Health Center for Women and Children, Chongqing, China
| | - Dianxun Fu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Wei
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
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Carbonnel M, Pirtea P, de Ziegler D, Ayoubi JM. Uterine factors in recurrent pregnancy losses. Fertil Steril 2021; 115:538-545. [PMID: 33712099 DOI: 10.1016/j.fertnstert.2020.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/29/2022]
Abstract
Congenital and acquired uterine anomalies are associated with recurrent pregnancy loss (RPL). Relevant congenital Müllerian tract anomalies include unicornuate, bicornuate septate, and arcuate uterus. Recurrent pregnancy loss has also been associated with acquired uterine abnormalities that distort the uterine cavity such as, notably, intrauterine adhesions, polyps, and submucosal myomas. Initial evaluation of women with RPLs should include an assessment of the uterine anatomy. Even if proof of efficacy of surgical management of certain uterine anomalies is often lacking for managing RPLs, surgery should be encouraged in certain circumstances for improving subsequent pregnancy outcome. Uterine anomalies such as uterine septa, endometrial polyps, intrauterine adhesions, and submucosal myomas are the primary surgical indications for managing RPLs.
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Affiliation(s)
- Marie Carbonnel
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
| | - Dominique de Ziegler
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France.
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Hopital Foch, Faculté de Médecine Paris Ouest, Suresnes, France
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Evangelisti G, Barra F, Moioli M, Sala P, Stigliani S, Gustavino C, Costantini S, Ferrero S. Prexasertib: an investigational checkpoint kinase inhibitor for the treatment of high-grade serous ovarian cancer. Expert Opin Investig Drugs 2020; 29:779-792. [PMID: 32539469 DOI: 10.1080/13543784.2020.1783238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction Patients with high-grade serous ovarian cancer (HGSOC) have a poor prognosis, and current chemotherapy regimens for treating advanced disease are far from satisfactory. Prexasertib (LY2606368) is a novel checkpoint kinase inhibitor (CHK) under investigation for the treatment of HGSOC. Data from a recent phase II trial showed promising efficacy and safety results for treating wild-type BRCA HGSOC. Areas covered This article reviews the available data on the pharmacokinetics, pharmacodynamics, clinical efficacy, and safety of prexasertib in the treatment of HGSOC. Expert opinion Until now, prexasertib demonstrated clinical activity in phase I and II clinical trial for treating wild-type BRCA HGSOC, whereas its promising efficacy as monotherapy and combined with olaparib in BRCA-mutated HGSOC has been preliminary evidenced only in phase I studies. Compared to other drugs of the same class, prexasertib showed a better tolerability profile, causing moderate hematological toxicity. Further studies are needed to confirm efficacy and safety profiles of prexasertib in combined regimens. New early clinical trials may investigate prexasertib administered with programmed cell death ligand 1 (PD-L1) and PI3 K inhibitors due to the preclinical evidence of a synergic action.
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Affiliation(s)
- Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
| | - Melita Moioli
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
| | - Paolo Sala
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,LILT - Lega Italiana per la Lotta contro i Tumori, Rome, Italy
| | - Sara Stigliani
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Sergio Costantini
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child, Health (Dinogmi), University of Genoa , Italy
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Uterine leiomyomas: correlation between histologic composition and stiffness via magnetic resonance elastography - a Pilot Study. Ginekol Pol 2020; 91:373-378. [PMID: 32542642 DOI: 10.5603/gp.a2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To evaluate magnetic resonance elastography as a tool for characterizing uterine leimyomas. MATERIAL AND METHODS At total of 12 women with symptomatic leiomyomas diagnosed in physical and ultrasound examinations were enrolled in this pilot study. Before surgery, all patients underwent magnetic resonance elastography of the uterus using a 1.5 T MR whole-body scanner (Optima, GE Healthcare, Milwaukee, WI, USA). Surgical specimens were forwarded for histological examination. The findings were allocated into 3 categories depending on the percentage content of connective tissue: below 15%, from 15 to 30% and more than 30%. The median stiffness of leiomyomas for each of the group was calculated. The U-Mann Whitney test was used for statistical analysis. RESULTS The stiffness of the leiomyomas ranged between 3.7-6.9 kPa (median value 4.9 kPa). The concentration of extracellular components in the leiomyomas did not exceed 40%. An increasing trend of the stiffness with the growing percentage of extracellular component was observed. Stiffness of the leiomyomas obtained by MRE varies depending on microscopic composition. CONCLUSIONS The value of stiffness shows a trend of increasing with the percentage of extracellular component of the leiomyoma. Further studies are required to assess the usefulness of MRE in diagnostics of uterine leiomyomas.
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Vahdat M, Mansouri G, Kashanian M, Mirzaei H, Mostafavi SRS, Shahesmaeili A. One-Step Resection via Hysteroscopic Myomectomy and Prostaglandin F2α for Large Submucosal Myoma. J Minim Invasive Gynecol 2020; 27:826-831. [PMID: 32105820 DOI: 10.1016/j.jmig.2019.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To assess the efficacy of prostaglandin F2α (PGF2α) in hysteroscopic myomectomy of submucous myomas. DESIGN Single-blind, randomized clinical trial study. SETTING Teaching hospital, affiliate of Iran University of Medical Sciences, Tehran, Iran. PATIENTS Forty-four patients with symptomatic submucous myomas were randomly assigned to the intervention group (n = 21; 1 excluded owing to myoma not identified on pathologic examination) and the control group (n = 22). INTERVENTIONS In the intervention group, PGF2α was injected into the cervix twice: before the beginning of the surgery and after the resection of the intrauterine portion of the submucous myoma. TIn the control group, the myomas were resected without the PGF2α injection. The same procedure was performed in the control group without the PGF2α injection. MEASUREMENTS AND MAIN RESULTS There were no differences in the demographics, size, or type of myomas among the groups at baseline. Although the proportion of complete removal of the submucous myomas in the intervention group (PGF2α) was higher (20/23 myomas or 87%) than that in the control group (15/23 myomas or 65.2%), the difference was not significant (p = .1). The number of 1-step complete removal of large submucous myomas (>5 cm) in the PGF2α group was significantly higher than that in the control group (8/10 myomas [80%] vs 2/8 myomas [25%], p = .03). The mean duration of operative time was significantly longer in the intervention group than in the control group (p = .01). The intervention group experienced more days of postoperative bleeding than the control group (p = .001). There were no differences regarding the length of stay at the hospital or hemoglobin levels between the groups (p = .07). CONCLUSION In the current study, injection of PGF2α was beneficial for 1-step complete resection of large (>5 cm) submucous myomas via hysteroscopic myomectomy.
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Affiliation(s)
- Mansoureh Vahdat
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran
| | - Ghazal Mansouri
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran.
| | - Maryam Kashanian
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran
| | - Hossein Mirzaei
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Reza Saadat Mostafavi
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- Endometriosis Research Center (Drs. Vahdat and Mansouri); Iran University of Medical Sciences, Tehran, Iran , (Dr. Kashanian); Department of Radiology, School of Medicine (Dr. Mostafavi), Iran University of Medical Sciences, Tehran; Department of Gynecology (Dr. Mansouri); HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health (Mr. Mirzaei and Dr. Shahesmaeili), Kerman University of Medical Sciences, Kerman, Iran
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Vidal-Mazo C, Forero-Diaz C, Lopez-Gonzalez E, Yera-Gilabert M, Machancoses FH. Clinical recurrence of submucosal myoma after a mechanical hysteroscopic myomectomy: Review after 5 years follow up. Eur J Obstet Gynecol Reprod Biol 2019; 243:41-45. [PMID: 31671290 DOI: 10.1016/j.ejogrb.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluation of five years follow up of the clinical recurrence after hysteroscopic myomectomies with MyoSure® morcellator in our district. STUDY DESIGN Premenopausal patients from April 2013 to October 2018, with symptoms of abnormal uterine bleeding, and/or infertility, and sonographic suspicion of submucosal myoma, confirmed by diagnostic hysteroscopy prior to myomectomy were included in the prospective, not randomized cohort study (N = 320). All patients had a follow up visit between three to six months post procedure. Further follow up was established by chart review. The information was extracted from the medical records. Patient characteristics were expressed as mean ± SD or median (interquartile range) for continuous data (assumption of normality assessed using the Kolmogorov-Smirnov test). Dependence relationship between presence of corporal myomas and the performance of a major long-term surgery, and between the amount of submucosal myomas and clinical recurrence throughout the 5 years of follow-up were studied were studied by χ2. RESULTS After one year follow up, no recurrence or symptoms were noted. 53 (16.6%) re-morcellations were performed due to incomplete resection. At the second year, three women who were discharged previously were classified as recurrence (0.9%). There were 99 women remaining to be evaluated (30.90%) in the second year. A percentage estimation of 5-6 recurrences with the 100% of women evaluated. In the third year, only one woman was classified as recurrence (0.3%), with 176 (55%) women not evaluated. At the fourth and fifth year of follow-up, 75% are still awaiting complete of the study five years. No relationship was observed in the presence of corporal myomas and recurrence throughout the 5 years of follow-up (χ2 = 0.000, p = 0.994). Dependence relationship was observed between the presence of corporal myomas and the performance of a major long-term surgery (χ2 = 11.757, p = .001, OR = 3.528). CONCLUSION In office hysteroscopic mechanical myomectomy with MyoSure® morcellator of submucosal fibromas was a highly effective therapy for women, at three years of follow-up. It appears to give satisfactory long-term results with a low recurrence rate and without significant complications.
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Affiliation(s)
- Cinta Vidal-Mazo
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain.
| | - Carmen Forero-Diaz
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Elga Lopez-Gonzalez
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Marta Yera-Gilabert
- Unidad de Gestión Clínica de Obstetricia y Ginecología, Hospital Juan Ramón Jiménez, Huelva, 21005, Spain
| | - Francisco H Machancoses
- Predepartmental Unit of Medicine, Faculty of Health Sciences, Jaume I University, Castellón de la Plana, 12071, Spain
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Song T, Han YG, Sung JH. Comparison between the vascular control technique and conventional technique for reducing operative blood loss during robot-assisted myomectomy. Int J Med Robot 2019; 15:e2038. [PMID: 31503368 DOI: 10.1002/rcs.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND This retrospective study aimed to compare the surgical outcomes and morbidity of the vascular control technique in robotic myomectomy with the conventional technique. METHODS Thirty-two consecutive patients who underwent robotic myomectomy using laparoscopic vascular clamps in 2017 to 2019 (the practice change cohort) were retrospectively comparted with 32 case-matched consecutive patients who underwent the conventional robotic myomectomy (the historical cohort). The primary outcome was the operative blood loss and hemoglobin change. RESULTS The two cohorts had similar baseline characteristics. The mean operative blood loss and hemoglobin changes were lower in the practice change cohort than in the historical cohort (P < .001 and P = .005, respectively). Other postoperative outcomes were similar between two cohorts. CONCLUSION The vascular control technique in robotic myomectomy appears to be effective and safe in the management of selective patients with symptomatic myomas.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Gi Han
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Łoziński T, Filipowska J, Gurynowicz G, Zgliczyńska M, Kluz T, Jędra R, Skowyra A, Ciebiera M. The effect of high-intensity focused ultrasound guided by magnetic resonance therapy on obstetrical outcomes in patients with uterine fibroids – experiences from the main Polish center and a review of current data. Int J Hyperthermia 2019; 36:582-590. [DOI: 10.1080/02656736.2019.1616117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tomasz Łoziński
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
| | - Justyna Filipowska
- Department of Obstetrics and Gynecology, Pro-Familia Hospital, Rzeszów, Poland
- Faculty of Medicine, Institute of Nursing and Health Sciences, University of Rzeszów, Rzeszów, Poland
| | - Grzegorz Gurynowicz
- Division of Perinatology and Women’s Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Zgliczyńska
- Students’ Scientific Association at the First Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kluz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rzeszów, Poland
| | - Robert Jędra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Artur Skowyra
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
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Sheyn D, Bretschnieder CE, Mahajan ST, El-Nashar S, Billow M, Ninivaggio CS. Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40. J Minim Invasive Gynecol 2018; 26:1076-1082. [PMID: 30385429 DOI: 10.1016/j.jmig.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women. DESIGN A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2). SETTING American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016. INTERVENTIONS Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication. MEASUREMENTS AND MAIN RESULTS After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, p = .03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, p = .54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, p = .01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR] = 8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aOR = 5.91; 95% CI, 1.7-9.63), total operating time (aOR = 1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aOR = 3.67; 95% CI, 2.31-5.8). CONCLUSION LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata.
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Affiliation(s)
- David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar).
| | - C Emi Bretschnieder
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar)
| | - Sherif El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Megan Billow
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Cara S Ninivaggio
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio)
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Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296:709-720. [PMID: 28819682 DOI: 10.1007/s00404-017-4490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist. METHODS The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
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Erian MMS, McLaren GR, Erian AM. Advanced Hysteroscopic Surgery: Quality Assurance in Teaching Hospitals. JSLS 2017; 21:e2016.00107. [PMID: 28729781 PMCID: PMC5508806 DOI: 10.4293/jsls.2016.00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Advanced hysteroscopic surgery (AHS) is a vitally important technique in the armamentarium for the management of many day-to-day clinical problems, such as menorrhagia, surgical excision of uterine myomata and septa in the management of female infertility, hysteroscopic excision of chronically retained products of conception (placenta accreta), and surgical removal of intramural ectopic pregnancy. In today's climate of accountability, it is necessary that gynecologists take a more active role in assuring the quality of their work. In this article, we discuss the quality assurance system from the point of view of the surgical audit meetings in some of the major teaching hospitals affiliated with the University of Queensland (Brisbane, Queensland, Australia).
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Affiliation(s)
- Mark M S Erian
- Associate Professor, Department of Obstetrics and Gynecology, University of Queensland, Brisbane, Queensland, Australia
| | - Glenda R McLaren
- Senior Consultant Obstetrician and Gynecologist, Mater Hospital, Raymond Terrace, South Brisbane, Queensland, Australia
| | - Anna-Marie Erian
- Senior House Officer, Prince Charles Hospital, Rode Road, Chermside, Queensland, Australia
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The Role of Minimally Invasive Gynecologic Surgery in Sub Saharan Africa. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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