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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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Albazee E, Sayad R, Elrashedy AA, Samy Z, Faraag E, Baradwan S, Samy A. Efficacy of oxytocics on reducing intraoperative blood loss during abdominal myomectomy: a systematic review and meta-analysis of randomized placebo-controlled trials. J Gynecol Obstet Hum Reprod 2022; 51:102358. [DOI: 10.1016/j.jogoh.2022.102358] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/07/2022] [Accepted: 03/14/2022] [Indexed: 11/25/2022]
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Danilyants N, Mamik MM, MacKoul P, van der Does LQ, Haworth L. Laparoscopic-assisted myomectomy: Surgery center versus outpatient hospital. J Obstet Gynaecol Res 2020; 46:490-498. [PMID: 31997510 PMCID: PMC7065249 DOI: 10.1111/jog.14197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/31/2019] [Indexed: 11/30/2022]
Abstract
Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.
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Affiliation(s)
| | - Mamta M Mamik
- Albert Einstein College of Medicine, New York, New York, USA
| | - Paul MacKoul
- The Center for Innovative GYN Care, Rockville, Maryland, USA
| | | | - Leah Haworth
- The Center for Innovative GYN Care, Rockville, Maryland, USA
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Mas A, Tarazona M, Dasí Carrasco J, Estaca G, Cristóbal I, Monleón J. Updated approaches for management of uterine fibroids. Int J Womens Health 2017; 9:607-617. [PMID: 28919823 PMCID: PMC5592915 DOI: 10.2147/ijwh.s138982] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Uterine anatomy and uterine fibroids (UFs) characteristics have been classically considered as almost a unique issue in gynecology and reproductive medicine. Nowadays, the management of UF pathology is undergoing an important evolution, with the patient's quality of life being the most important aspect to consider. Accordingly, surgical techniques and aggressive treatments are reserved for only those cases with heavy symptomatology, while the clinical diagnostic based on size and number of UFs remains in a second plane in these situations. Moreover, the development of several noninvasive surgical techniques, especially the appearance of ulipristal acetate as a medical etiological treatment, has substantially changed the clinical indications. As a consequence, after almost 2 decades without relevant updates, it has been necessary to update the protocols for the management of UFs in the Spanish Society of Gynecology and Obstetrics twice. Accordingly, we believe that it is necessary to translate our experience to protocolize the medical care for patients with UFs, incorporating these new therapeutic options, and selecting the best treatment for them. We highlight the importance of achieving the patient's goals and decisions by improving the clinical diagnosis for these type of pathologies, allowing enhanced personalized treatments, as well as the reduction of potential risks and unnecessary surgeries.
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Affiliation(s)
- Aymara Mas
- Reproductive Medicine Research Group, Institute of Health Research La Fe, University and Polytechnic Hospital La Fe, Valencia, Spain
- Research and Development Department, Igenomix Foundation, Valencia, Spain
| | - Marta Tarazona
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Joana Dasí Carrasco
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Gloria Estaca
- Obstetrics and Gynecology Department, La Zarzuela Hospital, Madrid, Spain
- Obstetrics and Gynecology Department, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ignacio Cristóbal
- Obstetrics and Gynecology Department, La Zarzuela Hospital, Madrid, Spain
- Obstetrics and Gynecology Department, Universidad Francisco de Vitoria, Madrid, Spain
| | - Javier Monleón
- Gynecology Department, University and Polytechnic Hospital La Fe, Valencia, Spain
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Atashkhoei S, Fakhari S, Pourfathi H, Bilehjani E, Garabaghi PM, Asiaei A. Effect of oxytocin infusion on reducing the blood loss during abdominal myomectomy: a double-blind randomised controlled trial. BJOG 2017; 124:292-298. [PMID: 27862855 DOI: 10.1111/1471-0528.14416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effectiveness and safety of oxytocin to reduce blood loss during abdominal myomectomy. DESIGN Double-blind randomised controlled trial. SETTING Obstetrics and Gynecologic University Medical Centre. POPULATION Eighty healthy women candidates for abdominal myomectomy. METHODS Women were randomly assigned to two groups. In the study group (n = 40) oxytocin 30 IU in 500 ml normal saline; and in the placebo group (n = 40) pure normal saline was administered during myomectomy. The main outcome measures were peri-operative blood loss and rates of blood transfusion. MAIN OUTCOME MEASURE Estimated intra-operative blood loss. RESULTS Estimated intra-operative blood loss in the study group (189.5 ± 16.72 ml) was significantly lower than the placebo group (692.25 ± 89.93 ml) (95% CI 672.54-711.96; P < 0.0001).The need for blood transfusion was significantly lower in the study group. Blood transfusions were required for three (7.5%) women in the study group and 10 (25%) women in the placebo group (95% CI 15.5-34.5; P < 0.001). CONCLUSIONS Intra-operative oxytocin infusion appears to be safe and effective in decreasing blood loss during abdominal myomectomy. TWEETABLE ABSTRACT Intra-operative oxytocin is effective in decreasing blood loss during abdominal myomectomy.
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Affiliation(s)
- S Atashkhoei
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - S Fakhari
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - H Pourfathi
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - E Bilehjani
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - P M Garabaghi
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - A Asiaei
- Women's Reproductive Health Research Center, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22:665-686. [PMID: 27466209 PMCID: PMC5853598 DOI: 10.1093/humupd/dmw023] [Citation(s) in RCA: 356] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 12/24/2022] Open
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
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Affiliation(s)
- Jacques Donnez
- Professor EM, Catholic University of Louvain, Director, Société de Recherche pour l'Infertilité (SRI), 143 Avenue Grandchamp, B-1150 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte B1.52.02, 1200 Brussels, Belgium
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Bailey AP, Jaslow CR, Kutteh WH. Minimally invasive surgical options for congenital and acquired uterine factors associated with recurrent pregnancy loss. ACTA ACUST UNITED AC 2015; 11:161-7. [PMID: 25776290 DOI: 10.2217/whe.14.81] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies before 20 weeks' gestation and may be caused by genetic, endocrinologic, anatomic and immunologic abnormalities. Anatomic uterine anomalies include congenital malformations (bicornuate, didelphic, septate and unicornuate uteri) and acquired defects (fibroids, adenomas, adhesions and polyps). Women with septate and bicornuate uteri, intrauterine adhesions, and some adenomas and fibroids are at increased risk of RPL. Data support surgical treatment of all of these lesions except bicornuate uteri. The role of polyps in RPL is unclear. Minimally invasive options for surgical correction of intrauterine lesions include hysteroscopy, laparoscopy with and without robotic assistance and minilaparotomy.
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Affiliation(s)
- Amelia P Bailey
- Minimally Invasive Surgery, Fertility Associates of Memphis, Memphis, TN 38120, USA
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Donnez J, Donnez O, Dolmans MM. With the advent of selective progesterone receptor modulators, what is the place of myoma surgery in current practice? Fertil Steril 2014; 102:640-8. [DOI: 10.1016/j.fertnstert.2014.06.041] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/16/2014] [Accepted: 06/26/2014] [Indexed: 11/26/2022]
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Chirurgie ambulatoire : évolution des techniques et de la prise en charge chirurgicale. Vers une chirurgie d’excellence. Presse Med 2014; 43:278-82. [DOI: 10.1016/j.lpm.2013.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 11/05/2013] [Indexed: 11/21/2022] Open
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Rice KE, Secrist JR, Woodrow EL, Hallock LM, Neal JL. Etiology, diagnosis, and management of uterine leiomyomas. J Midwifery Womens Health 2012; 57:241-7. [PMID: 22587581 DOI: 10.1111/j.1542-2011.2012.00176.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Uterine leiomyomas are the most common benign gynecologic tumors. While the true etiology of leiomyomas remains unknown, their origin is thought to be multifactorial including genetic, hormonal, and tissue growth factor variations. Leiomyomas are predominantly found in women of reproductive age and are the leading indication for hysterectomy worldwide. Menstrual irregularities, pain, and fertility difficulties may arise from leiomyoma presence, although many women remain asymptomatic. Diagnosis can be made via ultrasound or magnetic resonance imaging, when precise mapping of the tissue is needed. Many treatment options are available ranging from surgical to medical and should be chosen depending on symptom severity, number and size of leiomyomas, patient age, fertility desires, and patient preferences. The objective of this article is to present a practical clinical perspective on uterine leiomyomas and an overview of contemporary treatment options.
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Affiliation(s)
- Kate E Rice
- The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210-1289, USA
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Horng HC, Wen KC, Su WH, Chen CS, Wang PH. Review of myomectomy. Taiwan J Obstet Gynecol 2012; 51:7-11. [DOI: 10.1016/j.tjog.2012.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2012] [Indexed: 11/28/2022] Open
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Hirschelmann A, De Wilde RL. Plastic and reconstructive uterus operations by minimally invasive surgery? A review on myomectomy. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2012; 1:Doc09. [PMID: 26504693 PMCID: PMC4582479 DOI: 10.3205/iprs000009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Plastic and reconstructive uterus operations are performed in congenital uterine anomalies or benign uterine conditions. Congenital uterine anomalies are relatively rare diseases with various approaches for surgical treatment. Therefore, to address the question of the usefulness of a minimally invasive approach in plastic uterus operations, the most common uterine condition which requires reconstructive surgery, namely myomectomy, is discussed. METHOD Searches were conducted in PubMed and The Cochrane Library to identify relevant literature. FINDINGS Compared with myomectomy by laparotomy and minilaparotomy, laparoscopic myomectomy is associated with improved short-term outcomes. Laparoscopy is further associated with less adhesion formation. Pregnancy rates after myomectomy in symptomatic patients might be higher after laparoscopy than after laparotomy. Although uterine ruptures following laparoscopic myomectomy are described in the literature, it seems to be a rare event. Concerning the recurrence, there is evidence that rates are similar after laparoscopy and laparotomy. CONCLUSION Myomectomy by laparoscopy has several advantages over abdominal myomectomy (by conventional laparotomy and minilaparotomy) and should be the standard procedure. Despite the advantages of laparoscopy, abdominal myomectomy is still a frequently performed procedure. Lack of training in advanced laparoscopic procedures hampers the wide-spread use of laparoscopic myomectomy. Due to the advantages of laparoscopic surgery, efforts should be made to implement this procedure into daily practice. To provide the best care, physicians should offer patients the opportunity of a laparoscopic treatment of myomas.
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Affiliation(s)
- Anja Hirschelmann
- Pius-Hospital Oldenburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Oldenburg, Germany
| | - Rudy Leon De Wilde
- Pius-Hospital Oldenburg, Klinik für Frauenheilkunde, Geburtshilfe und Gynäkologische Onkologie, Oldenburg, Germany
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Hors fertilité, place de la myomectomie en périménopause et après la ménopause. ACTA ACUST UNITED AC 2011; 40:902-17. [DOI: 10.1016/j.jgyn.2011.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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XIROMERITIS P, KALOGIANNIDIS I, PAPADOPOULOS E, PRAPAS N, PRAPAS Y. Improved recovery using multimodal perioperative analgesia in minimally invasive myomectomy: A randomised study. Aust N Z J Obstet Gynaecol 2011; 51:301-6. [DOI: 10.1111/j.1479-828x.2011.01333.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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