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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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Laparoendoscopic two-site myomectomy (LETS-M) using conventional laparoscopic instruments and the glove-port technique. J Formos Med Assoc 2022; 121:2248-2256. [DOI: 10.1016/j.jfma.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/24/2022] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
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Abstract
Minimally invasive surgery continues to transform the field of gynecological surgery and is now the standard of care for the surgical treatment of many diseases in gynecology. Owing to minimally invasive surgery's clear advantages, new advances in technology are being employed rapidly and enabling even the most complicated procedures to be performed less invasively. We examine recent literature on minimally invasive surgical innovations, advances, and common practices in benign gynecology that, from our point of view, made an impact on the way laparoscopic surgery is performed and managed in the last decade.
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Affiliation(s)
- Lior Levy
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jim Tsaltas
- Gynaecological Endoscopy and Endometriosis Surgery, Department of Obstetrics and Gynaecology Monash Health, Monash University, Melbourne, Victoria, Australia
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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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Pepin K, Cope A, Einarsson JI, Cellini J, Cohen SL. Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review. J Minim Invasive Gynecol 2020; 28:619-643. [PMID: 32977002 DOI: 10.1016/j.jmig.2020.09.013] [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: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas. DATA SOURCES Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020. METHODS OF STUDY SELECTION Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis. TABULATION, INTEGRATION, AND RESULTS The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen. CONCLUSION Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.
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Affiliation(s)
- Kristen Pepin
- Department of Obstetrics & Gynecology, Weill Cornell Medical Center, New York, New York (Dr. Pepin).
| | - Adela Cope
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
| | - Jon I Einarsson
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital (Dr. Einarsson)
| | - Jacqueline Cellini
- Department of Research & Instruction, Harvard TH Chan School of Public Health (Ms. Cellini), Boston, Massachusetts
| | - Sarah L Cohen
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
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Gasless Laparoscopic Myomectomy Using A J-shaped Retractor and Suture Technique. Surg Laparosc Endosc Percutan Tech 2020; 30:356-360. [PMID: 32788566 DOI: 10.1097/sle.0000000000000794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to compare gasless single-port access (SPA) laparoscopic myomectomy using a J-shaped retractor and conventional SPA laparoscopic myomectomy. STUDY DESIGN The medical records of 60 patients who underwent laparoscopic myomectomy between January 2016 and August 2019 were reviewed. Thirty patients underwent gasless SPA laparoscopic myomectomy using a J-shaped retractor, and 30 patients underwent conventional SPA laparoscopic myomectomy. The 2 groups were compared in terms of surgical outcomes. In gasless laparoscopic myomectomy, closure of the uterine defect after myomectomy was performed using an extracorporeal suture technique with a Kelly clamp and knot pusher. RESULTS On comparing gasless SPA and conventional SPA laparoscopic myomectomy, no significant differences were observed in age, body mass index, parity, previous abdominal surgery, and size of the dominant uterine myoma. The median retraction setup time from skin incision was 8 minutes (range, 5 to 15 min) with gasless SPA laparoscopic myomectomy. The median total operation times were 105 minutes (range, 62 to 210 min) with gasless SPA myomectomy and 110 minutes (range, 60 to 270 min) with conventional SPA myomectomy, and there was no significant difference (P=0.251). There was no difference between the groups in terms of estimated blood loss. None of the patients experienced laparotomy conversion in both groups. No major complications, such as urologic, bowel, and vessel injuries, were found in both groups. CONCLUSION Gasless SPA laparoscopic myomectomy using a J-shaped retractor is a safe and feasible approach, which allows for easy and convenient suturing of a uterine defect after myomectomy.
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A systematic review and meta-analysis comparing single port laparoscopic myomectomy with conventional laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2019; 239:52-59. [DOI: 10.1016/j.ejogrb.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 12/29/2022]
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Lee D, Kim SK, Kim K, Lee JR, Suh CS, Kim SH. Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study. J Minim Invasive Gynecol 2017; 25:124-132. [PMID: 28826957 DOI: 10.1016/j.jmig.2017.08.651] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE To compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects. DESIGN Prospective randomized controlled trial (Canadian Task Force classification I). SETTING University hospital. PATIENTS Women with uterine myoma scheduled for laparoscopic myomectomy. INTERVENTIONS Sixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS There were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0 ± 3.2 vs 18.3 ± 4.8; p < .001) and 8 weeks (9.9 ± 3.2 vs 14.3 ± 3.8; p < .001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6 ± 7.2 vs 18.5 ± 12.8; p = .024) and 8 weeks (9.5 ± 6.0 vs 18.8 ± 9.1; p < .001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7 ± 6.3 mL vs 16.4 ± 6.2 mL; p = .039). Operative outcomes were similar in the 2 groups. CONCLUSION SP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities.
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Affiliation(s)
- Dayong Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung Ryeol Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea
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Amemiya K, Adachi K, Sasamoto N, Yamamoto Y. Transumbilical extraction of 151-300-g myomas without morcellator versus conventional laparoscopic myomectomy with power morcellator. Gynecol Minim Invasive Ther 2017; 6:162-166. [PMID: 30254906 PMCID: PMC6135198 DOI: 10.1016/j.gmit.2017.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/20/2017] [Accepted: 06/01/2017] [Indexed: 12/27/2022] Open
Abstract
Study objective: The aim of this study was to compare the surgical outcomes, particularly the specimen retrieval time, between two methods of laparoscopic myomectomy: transumbilical retrieval of the myoma without a morcellator and conventional retrieval of the myoma using a power morcellator via the left lower quadrant. Design: Retrospective study. Setting: Public hospital. Patients: Seventy-four women undergoing laparoscopic myomectomy. Interventions: Laparoscopic myomectomy followed by myoma retrieval via transumbilical extraction or electric motorized morcellator extraction. Measurements and main results: Seventy-four patients undergoing laparoscopic myomectomy followed by myoma retrieval via transumbilical extraction or electric motorized morcellator extraction were studied. Significant differences were observed in the average weight of the retrieved myomas between the transumbilical and morcellator groups (141.0 vs. 262.8 g, respectively; p < 0.001). Therefore, we chose 27 patients whose total specimen weight was 151–300 g; 13 patients were in the transumbilical extraction group and 14 were in the electric motorized morcellator group. No significant differences were observed in patient characteristics between the two groups. The operative time, blood loss volume, and myoma retrieval time were similar between the two groups. Conclusion: Laparoscopic myomectomy with transumbilical extraction for myoma retrieval is a feasible method for specimens weighing up to 300 g.
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Affiliation(s)
- Kyoka Amemiya
- Department of Obstetrics and Gynecology, Itami City Hospital, Hyogo, Japan
| | - Kazushige Adachi
- Department of Obstetrics and Gynecology, Minoh City Hospital, Osaka, Japan
| | - Naoko Sasamoto
- Department of Obstetrics and Gynecology, Minoh City Hospital, Osaka, Japan
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Abdusattarova K, Mettler L, Alkatout I, Dempfle A. Endoscopic treatment of symptomatic fibroids at reproductive age and beyond. MINIM INVASIV THER 2017; 26:355-361. [DOI: 10.1080/13645706.2017.1312457] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Khulkar Abdusattarova
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, University Clinic Schleswig-Holstein, Kiel, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
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Single-incision laparoscopic myomectomy: A review of the literature and available evidence. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Kim SM, Baek JM, Park EK, Jeung IC, Choi JH, Kim CJ, Lee YS. A Comparison of Single-, Two- and Three-Port Laparoscopic Myomectomy. JSLS 2015; 19:e2015.00084. [PMID: 26648680 PMCID: PMC4653583 DOI: 10.4293/jsls.2015.00084] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE A recent FDA safety communication has discouraged the use of a power morcellator for myoma extraction and has called for a change in surgical techniques for myomectomy. The objective of this study was to compare surgical outcomes of laparoscopic single-, two-, and conventional three-port myomectomy and to evaluate the feasibility of contained manual morcellation for uterine myoma. METHODS This retrospective study was a review and analysis of data from 191 consecutive women who underwent single-, two-, or three-port myomectomy for the management of uterine myoma from January 1, 2009, through December 31, 2014. RESULTS The 3 study groups did not differ demographically. Apart from operative time, the single- and two-port groups showed operative outcomes comparable to those of the multiport group. The single-port group had significantly longer operative times (P = .0053) than the two- and three-port groups. However, in the latter half of the single-port cases, the operative time was similar to those in the three-port group. The two-port surgery group showed a consistent operative time without a learning period. CONCLUSION Single- or two-port myomectomy with transumbilical myoma morcellation is feasible and safe, with outcomes comparable to those of three-port myomectomy. These results suggest the potential for minimally invasive management of symptomatic uterine myoma, without the use of a power morcellator.
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Affiliation(s)
- Su Mi Kim
- Department of Obstetrics and Gynecology
| | - Jong Min Baek
- Department of General Surgery, The Catholic University of Korea, Bucheon St. Mary's Hospital, Seoul, Korea
| | | | | | - Ji Hyang Choi
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
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