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Gigg M, Goldrath K, Havard A, Nguyen AV, Kwan L, Parvataneni R, Mehta S, Chiang A, Rodriguez V, Fahey J. Determination of Whole Blood Loss From Minimally Invasive Myomectomy Using a Standardized Formula: A Pilot Study. J Minim Invasive Gynecol 2024; 31:488-495. [PMID: 38437978 DOI: 10.1016/j.jmig.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
STUDY OBJECTIVE To determine the median perioperative blood loss (PBL) during minimally invasive surgical (MIS) myomectomy. DESIGN Prospective pilot study. SETTING Large academic teaching hospital. PATIENTS Thirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging. INTERVENTIONS A CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit - postoperative hematocrit)/preoperative hematocrit. MEASUREMENTS AND MAIN RESULTS Median PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion. CONCLUSION Calculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.
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Affiliation(s)
- Marisa Gigg
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Kathryn Goldrath
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Alexandra Havard
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Anissa V Nguyen
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California (Ms. Nguyen, Kwan)
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California (Ms. Nguyen, Kwan)
| | - Ram Parvataneni
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Sukrant Mehta
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Alexander Chiang
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Valentina Rodriguez
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey)
| | - Jacqueline Fahey
- Department of OB/GYN, David Geffen School of Medicine at UCLA, Los Angeles, California (Drs. Gigg, Goldrath, Havard, Parvataneni, Mehta, Chiang, Rodriguez, Fahey).
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Cooper NAM, Daniels NF, Magama Z, Aref-Adib M, Odejinmi F. Opportunities for change and levelling up: a trust wide retrospective analysis of 8 years of laparoscopic and abdominal myomectomy. Facts Views Vis Obgyn 2024; 16:195-201. [PMID: 38950533 DOI: 10.52054/fvvo.16.2.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Laparoscopic myomectomy is increasingly considered the gold standard uterine preserving procedure and has well documented benefits over the open approach. Barriers that women have in accessing the most appropriate treatment need to be addressed to ensure optimal patient care and outcomes. Objectives To analyse rates of open and laparoscopic myomectomy at a large NHS trust and identify how many cases could potentially have been performed laparoscopically, and any variation between sites. Materials and Methods A retrospective review of preoperative imaging reports and a surgical database containing information for all myomectomies performed between 1st January 2015 and 31st December 2022. Main outcome measures Number of procedures suitable for alternative surgical approach; length of hospital stay; estimated blood loss; cost differences. Results 846 myomectomies were performed; 656 by laparotomy and 190 by laparoscopy. 194/591 (32.8%) open myomectomies could have been performed laparoscopically and 26/172 (15.1%) laparoscopic myomectomies may have been better performed via an open approach. Length of hospital stay, and estimated blood loss were significantly higher in the open group. Had cases been performed as indicated by pre-operative imaging, the cost differences ranged from -£115,752 to £251,832. Conclusions There is disparity in access to the gold standard care of laparoscopic myomectomy. Due to multifactorial reasons, even at sites where the rate of laparoscopic myomectomy is high, there is still underutilisation of this approach. It is clear that there is scope for change and "levelling up" of this imbalance. What is new? Robust pathways and guidelines must be developed, and more laparoscopic surgeons should be trained to optimise care for women with fibroids.
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Tsiampa E, Tsiampas K, Kapogiannis F. Perioperative and reproductive outcomes' comparison of mini-laparotomy and laparoscopic myomectomy in the management of uterine leiomyomas: a systematic review. Arch Gynecol Obstet 2024; 309:821-829. [PMID: 37566224 DOI: 10.1007/s00404-023-07168-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To evaluate and compare mini-laparotomy (MLPT) with laparoscopic (LPS) myomectomy perioperative and reproductive outcomes. METHODS We systematically searched for related articles in the MEDLINE, Embase, Web of Science and the Cochrane library databases. Nine studies (4 randomized, 3 retrospective, 1 prospective and 1 case-control study) which involved 1723 patients met the inclusion criteria and were considered eligible for inclusion. RESULTS Demographic characteristics were similar between the two groups. LPS was associated with shorter hospital stay (p = 0.04), lower blood loss (p < 0.00001), shorter duration of median ileus (p < 0.00001) and fewer episodes of postoperative fever (p = 0.04). None of the reproductive factors examined (pregnancy rate, preterm delivery, vaginal delivery and delivery with caesarean section) in women diagnosed with unexplained infertility and/or symptomatic leiomyomas reached statistical significance although the results represent a small size effect. CONCLUSION Our analysis demonstrated that LPS seems to be an alternative, safe and reliable surgical procedure for uterine leiomyoma treatment and in everyday practice seems to offer improved outcomes-regarding at least the perioperative period-over MLPT.
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Affiliation(s)
- Eleni Tsiampa
- 2nd Department of Obstetrics and Gynecology, General and Maternity Hospital Helena Venizelou, Christou Vournazou Str. 1, 11521, Athens, Greece.
| | - Konstantinos Tsiampas
- Laparoscopic Department of Obstetrics and Gynecology, Iaso General Hospital, Athens, Greece
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Gümüsburun N, Yapca OE, Ozdes S, Al RA. Triple vs. single uterine tourniquet to reduce hemorrhage at myomectomy: a randomized trial. Arch Gynecol Obstet 2023; 308:1811-1816. [PMID: 37672088 DOI: 10.1007/s00404-023-07201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/21/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE This study aimed to compare the effect of triple uterine tourniquet and single tourniquet on intraoperative blood loss during open myomectomy. METHODS Women were randomized to undergo open myomectomy with a triple (n = 30) or single uterine tourniquet (n = 30). All symptomatic women aged 18-48 who had three or more myomas or at least one myoma greater than 8 cm if there were less than three myomas were eligible for the study. The primary outcome variable was the volume of intraoperative blood loss. The sample size was set to detect a 240 ml difference in blood loss with 80% power at α = 0.05, with an effect size of 0.8. The rate of transfusions, change in hemoglobin, volume of drains, operation time, tourniquet time, and perioperative complications were secondary outcomes. RESULTS We found no significant difference in intraoperative blood loss between triple and single uterine tourniquets (527 [102-2931]) ml vs. 508 [172-2764] ml, p = 0.238). Between the single and triple tourniquet groups, the median weight of myoma (379 [136-3850] vs. 330 [140-1636] g, p = 0.451) and median number (1 [1-18] vs. 2 (1-13), p = 0.214), total operation time (84 ± 31 min vs. 79 ± 27 min, p = 0.503), ischemia time (35 ± 21 min vs. 30 ± 14 min., p = 0.238), drain volume at 48th hour (196 ± 89)ml vs. 243 ± 148 ml, p = 0.144) and decrease in hemoglobin (2.3 ± 1.8 g/dl vs. 2.8 ± 1.4 g/dl, p = 0.437) were similar. Eight (27%) patients in the triple tourniquet group and 12 (40%) patients in the single tourniquet group were transfused (p = 0.273). One patient underwent hysterectomy 6-8 h after myomectomy in a single tourniquet group. CONCLUSION There was no clinically significant difference in intraoperative blood loss between triple and single uterine tourniquets during open myomectomy. CLINICAL TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION ClinicalTrials.gov ID: NCT02392585, 03/13/2015.
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Affiliation(s)
- Neset Gümüsburun
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ataturk University, 25240, Erzurum, Turkey
| | - Omer E Yapca
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ataturk University, 25240, Erzurum, Turkey
| | - Sevda Ozdes
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ataturk University, 25240, Erzurum, Turkey
| | - Ragıp A Al
- Faculty of Medicine, Department of Obstetrics and Gynecology, Ataturk University, 25240, Erzurum, Turkey.
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Kuru O, Erkan IBO, Bicer E. The concern about the educational quality of online videos on laparoscopic myomectomy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230736. [PMID: 37971128 PMCID: PMC10645182 DOI: 10.1590/1806-9282.20230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the surgical content of the 50 most-viewed laparoscopic myomectomy videos on YouTube while evaluating the educational quality and accuracy of the videos. METHODS In this cross-sectional study, the keyword "laparoscopic myomectomy" was searched in publicly available content on YouTube, and the videos were sorted by view count using YouTube's advanced search options. Out of the first 66 videos, only 50 were eligible according to our selection criteria. One associate professor of gynecology and one gynecology resident watched these videos independently and evaluated the quality and surgical aspects. Our primary outcome was the scores of the Quality Criteria for Consumer Health Information and Global Quality Score and the features of the surgical technique. RESULTS The 50 most-viewed laparoscopic myomectomy videos were uploaded between 2010 and 2021. They had a mean of 66636.6±103772.2 views. According to the Quality Criteria for Consumer Health Information criteria, 78% of the videos were categorized as "poor," 12% of them were "fair," and 10% of them were "very poor." The indication of the surgery was not specified in 27 (54%) of them. The surgeons in 39 (79.6%) of the videos did not use any containment system for the power morcellation, even though it was restricted by the United States Food and Drug Administration. The preoperative and perioperative precautions to minimize blood loss were underemphasized. There was no scientific evidence in 49 (98%) of the videos. CONCLUSION Laparoscopic myomectomy videos on YouTube are limited in terms of providing evidence-based and well-organized scientific knowledge.
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Affiliation(s)
- Oguzhan Kuru
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology – İstanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology – İstanbul, Turkey
| | - Elifnur Bicer
- Erbaa State Hospital, Department of Obstetrics and Gynecology – Tokat, Turkey
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Hindman N, Kang S, Fournier L, Lakhman Y, Nougaret S, Reinhold C, Sadowski E, Huang JQ, Ascher S. MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma: A Consensus Statement. Radiology 2023; 306:e211658. [PMID: 36194109 PMCID: PMC9885356 DOI: 10.1148/radiol.211658] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 01/26/2023]
Abstract
Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected uterine leiomyosarcoma (LMS) throughout the pelvis of a physician treated for symptomatic leiomyoma. Research since that time suggests a higher prevalence than previously suspected of uterine LMS in resected masses presumed to represent leiomyoma, as high as one in 770 women (0.13%). Though rare, the dissemination of an aggressive malignant neoplasm due to noncontained electromechanical morcellation in laparoscopic myomectomy is a devastating outcome. Gynecologic surgeons' desire for an evidence-based, noninvasive evaluation for LMS is driven by a clear need to avoid such harms while maintaining the availability of minimally invasive surgery for symptomatic leiomyoma. Laparoscopic gynecologists could rely upon the distinction of higher-risk uterine masses preoperatively to plan oncologic surgery (ie, potential hysterectomy) for patients with elevated risk for LMS and, conversely, to safely offer women with no or minimal indicators of elevated risk the fertility-preserving laparoscopic myomectomy. MRI evaluation for LMS may potentially serve this purpose in symptomatic women with leiomyomas. This evidence review and consensus statement defines imaging and disease-related terms to allow more uniform and reliable interpretation and identifies the highest priorities for future research on LMS evaluation.
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Affiliation(s)
- Nicole Hindman
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Stella Kang
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Laure Fournier
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Yulia Lakhman
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Stephanie Nougaret
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Caroline Reinhold
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Elizabeth Sadowski
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Jian Qun Huang
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
| | - Susan Ascher
- From the Departments of Radiology (N.H., S.K.) and Gynecology
(J.Q.H.), NYU Grossman School of Medicine, 660 First Ave, 3rd Floor, New York,
NY 10016; Department of Radiology, Université Paris Cité, AP-HP,
Hôpital Européen Georges Pompidou, PARCC UMRS 970, INSERM, Paris,
France (L.F.); Department of Radiology, Memorial Sloan Kettering Cancer Center,
New York, NY (Y.L.); Department of Radiology, Cancer Institute Montpellier,
Montpellier, France (S.N.); Department of Radiology, McGill University,
Montreal, Quebec, Canada (C.R.); Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, Wis (E.S.); and
Department of Radiology, Georgetown University School of Medicine, Washington,
DC (S.A.)
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Panesar H, Dhaliwal HS. Iatrogenic Parasitic Leiomyomas: A Late and Uncommon Complication After Laparoscopic Morcellation. Cureus 2022; 14:e24718. [PMID: 35676984 PMCID: PMC9166603 DOI: 10.7759/cureus.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/05/2022] Open
Abstract
Parasitic leiomyoma (PL) is an extremely rare variant of uterine leiomyomas that occurs outside of the uterus and can often present like intra-abdominal tumors. The aim of this study is to report a case of PL and compare it with current literature. We present a rare case of a 45-year-old female who presented with bloating and spasmodic abdominal cramps for a two-month duration. She had a previous laparoscopic myomectomy six years ago. Transvaginal ultrasound (TVUS) showed solid vascular masses in the pelvis, the largest being 6 cm. Computed tomography (CT) of the thorax, abdomen, and pelvis (CTTAP) revealed further peritoneal masses in the left paracolic gutter suggesting peritoneal distant metastasis. Laparoscopy was completed, and biopsy and histopathological examination confirmed the diagnosis of parasitic leiomyoma. The patient opted for a bilateral salpingo-oophorectomy (BSO) creating iatrogenic menopause. One-year follow-up CT showed a reduction in the size of fibroids. PL can present with vague symptoms, typically nonspecific abdominal pain and cramping. It can often be confused with intra-abdominal tumors. It should be suspected in patients with previous uterine procedures. Histopathological examination is crucial for diagnostic and surgical management.
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Affiliation(s)
- Harrypal Panesar
- Otolaryngology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
| | - Harjit S Dhaliwal
- Department of Obstetrics and Gynaecology, Royal Bournemouth Hospital, Bournemouth, GBR
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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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Giovannopoulou E, Prodromidou A, Blontzos N, Iavazzo C. The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature. Surg Innov 2021; 28:352-359. [PMID: 33555235 DOI: 10.1177/1553350620988227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.
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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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11
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Opoku-Anane J, Vargas MV, Marfori CQ, Moawad G, Maasen MS, Robinson JK. Intraoperative tranexamic acid to decrease blood loss during myomectomy: a randomized, double-blind, placebo-controlled trial. Am J Obstet Gynecol 2020; 223:413.e1-413.e7. [PMID: 32229194 DOI: 10.1016/j.ajog.2020.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/18/2019] [Accepted: 02/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myomectomy is associated with a significant risk of hemorrhage. Tranexamic acid is a synthetic lysine derivative with antifibrinolytic activity used in other surgical disciplines to reduce blood loss during surgery. However, its utility in gynecologic surgery is not well understood. OBJECTIVE This study aimed to determine the effect of early administration of intravenous tranexamic acid on perioperative bleeding and blood transfusion requirements in women undergoing myomectomy. STUDY DESIGN This study was a double-blinded, randomized, placebo-controlled trial conducted in an academic teaching hospital. Women with symptomatic fibroids thought to be at risk for large intraoperative blood loss who met the following criteria were included in the study: (1) at least 1 fibroid ≥10 cm, (2) any intramural or broad ligament fibroid ≥6 cm, and/or (3) at least 5 total fibroids based on preoperative imaging. Patients were randomized to receive a single intravenous bolus injection of tranexamic acid 15 mg/kg (intervention group) versus an intravenous bolus injection of saline of equivalent volume (placebo group) 20 minutes before the initial surgical incision. Perioperative bleeding was defined by measuring intraoperative estimated blood loss, change between pre- and postoperative hemoglobin, and frequency of blood transfusions. Estimated blood loss was calculated by combining the blood volume collected within the suction canister and the weight of used sponges. The 2 groups were compared for age; body mass index; perioperative hemoglobin and hematocrit; perioperative blood loss; duration of surgery; blood transfusion requirements; and the number, total weight, and volume of myomas removed. RESULTS A total of 60 patients (30 per arm) were enrolled into the study between March 1, 2015, and January 29, 2018. Age, body mass index, baseline hemoglobin and/or hematocrit, number and total weight of myomas removed, and size of myomas did not differ between arms. Of 60 patients, 32 (53%) had laparoscopic myomectomy, 24 (40%) had robotic myomectomy, and 4 (7%) had laparotomy. Median estimated blood loss was 200 mL for the tranexamic acid group and 240 mL for the placebo group (P=.88). There was no difference in median duration of surgery (165 vs 164 minutes; P=.64) or change in perioperative hemoglobin (1.00 vs 1.1 g/dL; P=.64). Patients in the tranexamic acid group did not require blood transfusions; however, 4 patients (13.3%) in the placebo group (P=.11) required blood transfusions. CONCLUSION Intravenous administration of tranexamic acid in patients undergoing laparoscopic or robotic myomectomies was not associated with decreased blood loss.
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12
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Myomectomy associated blood transfusion risk and morbidity after surgery. Fertil Steril 2020; 114:175-184. [PMID: 32532486 DOI: 10.1016/j.fertnstert.2020.02.110] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate blood transfusion risks and the associated 30-day postoperative morbidity after myomectomy. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) Women who underwent myomectomies for symptomatic uterine fibroids (N = 3,407). INTERVENTION(S) Blood transfusion during or within 72 hours after myomectomy. MAIN OUTCOME MEASURE(S) The primary outcomes were rate of blood transfusion with myomectomy and risk factors associated with receiving a transfusion. The secondary outcome was 30-day morbidity after myomectomy. RESULT(S) The overall rate of blood transfusion was 10% (hysteroscopy, 6.7%; laparoscopy, 2.7%; open/abdominal procedures, 16.4%). Independent risk factors for transfusion included as follows: black race (adjusted odds ratio [aOR] 2.27, 95% confidence interval [CI] 1.62-3.17) and other race (aOR 1.77, 95% CI 1.20-2.63) compared with white race; preoperative hematocrit <30% compared to ≥30% (aOR 6.41, 95% CI 4.45-9.23); preoperative blood transfusion (aOR 2.81, 95% CI 1.46-5.40); high fibroid burden (aOR 1.91, 95% CI 1.45-2.51); prolonged surgical time (fourth quartile vs. first quartile aOR 11.55, 95% CI 7.05-18.93); and open/abdominal approach (open/abdominal vs. laparoscopic aOR 9.06, 95% CI 6.10-13.47). Even after adjusting for confounders, women who required blood transfusions had an approximately threefold increased risk for experiencing a major postoperative complication (aOR 2.69, 95% CI 1.58-4.57). CONCLUSION(S) Analysis of a large multicenter database suggests that the overall risk of blood transfusion with myomectomy is 10% and is associated with an increased 30-day postoperative morbidity. Preoperative screening of women at high risk for transfusion is prudent as perioperative transfusion itself leads to increased major postoperative complications.
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13
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Ye M, Zhou J, Chen J, Yan L, Zhu X. Analysis of hidden blood loss and its influential factors in myomectomy. J Int Med Res 2020; 48:300060520920417. [PMID: 32397777 PMCID: PMC7223209 DOI: 10.1177/0300060520920417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/24/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study was performed to quantify hidden blood loss (HBL) and explore its influential factors in myomectomy. METHODS Two hundred nine patients who underwent myomectomy by laparotomy or laparoscopy from 1 January 2017 to 31 December 2018 were analyzed. Each patient's estimated blood volume and total blood loss (TBL) were calculated by the Nadler formula and Gross formula, respectively. The HBL was calculated by subtracting the visible blood loss (VBL) from the TBL. A multivariate linear stepwise analysis was applied to identify the influential factors of HBL in myomectomy. RESULTS The mean perioperative VBL and estimated TBL during myomectomy were 137.81 ±104.43 and 492.24 ± 225.00 mL, respectively. The mean HBL was 354.39 ± 177.69 mL, which accounted for 71.52% ± 15.75% of the TBL and was two to three times higher than the VBL. The duration of surgery, number of removed leiomyomas, and location of removed leiomyomas were independent risk factors for HBL in myomectomy. CONCLUSIONS HBL accounted for a significant percentage of TBL in myomectomy. A full understanding of the HBL in perioperative blood management may improve patients' postoperative rehabilitation.
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Affiliation(s)
- Miaomiao Ye
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junhan Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingjing Chen
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Linzhi Yan
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Odejinmi F, Aref-Adib M, Liou N, Sideris M, Mallick R. Rethinking the Issue of Power Morcellation of Uterine Fibroids: Is Morcellation the Real Problem or Is this Another Symptom of Disparity in Healthcare Provision? In Vivo 2020; 33:1393-1401. [PMID: 31471384 DOI: 10.21873/invivo.11616] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Power morcellation remains one of the most significant developments in minimal access surgery over the past decade, allowing many more patients to benefit from the least invasive surgical route. However, its use is not without controversy, particularly with regards to the risks of an undiagnosed leiomyosarcoma. Increased media and, in particular, on-going social media coverage since events in 2014 have only served to intensify the debate, culminating in the Food and Drug Administration essentially 'banning' its use in the USA. Practice however continues to vary and this technique remains widely used in Europe and in particular the UK. The aim of this article was to review the development of power morcellation in gynaecology and the underlying risks, including that of undiagnosed leiomyosarcoma, as well as appraise the evolving literature on patient awareness and informed consent and the wider implications of morcellation restriction.
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Affiliation(s)
| | | | - Natasha Liou
- Whipps Cross Hospital, Barts Health NHS Trust, London, U.K
| | - Michail Sideris
- Women's Health Research Unit, Queen Mary University of London, London, U.K
| | - Rebecca Mallick
- Princess Royal Hospital, Brighton and Sussex University Hospitals NHS Trust, Haywards Heath, U.K.
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15
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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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16
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Sleiman Z, Baba RE, Garzon S, Khazaka A. The Significant Risk Factors of Intra-Operative Hemorrhage during Laparoscopic Myomectomy: A Systematic Review. Gynecol Minim Invasive Ther 2019; 9:6-12. [PMID: 32090006 PMCID: PMC7008653 DOI: 10.4103/gmit.gmit_21_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/06/2019] [Accepted: 05/16/2019] [Indexed: 12/25/2022] Open
Abstract
Laparoscopic myomectomy (LM) is becoming increasingly common in the management of uterine myomas and is usually offered regardless of the number, location, and size of the myomas. It has a generally low rate of periprocedural complications and is preferred to laparotomy for several reasons that are not limited to decreased length of hospital stay, number of sutures, smaller incisions, and decreased pain. However, blood loss during LM remains a challenge. To be able to stratify patients and provide better management after LM, it is crucial to identify these predictors of blood loss. Therefore, the aim of this review was to identify the risk factors for periprocedural blood loss after laparoscopic uterine myomectomy. According to our data synthesis, age, body mass index, and phase of the menstrual cycle do not seem to affect the blood loss during LM. Conversely, size and number of myomas, as well as operative time, was directly related to the increase of blood loss.
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Affiliation(s)
- Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University, Beirut, Lebanon
| | - Rania El Baba
- Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Aline Khazaka
- Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
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17
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Marín-Buck A, Karaman E, Amer-Cuenca JJ, Lisón JF, Török P, Karaaslan O, Valenti G, Zito G, Biondi A, Chiofalo B. Minimally Invasive Myomectomy: An Overview on the Surgical Approaches and a Comparison with Mini-Laparotomy. J INVEST SURG 2019; 34:443-450. [PMID: 31322011 DOI: 10.1080/08941939.2019.1642422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Uterine fibroids (UFs) are the most common benign solid tumors of the female genital tract manageable by surgical of pharmacological approach. When the medical management is ineffective or surgery is primarily requested, several surgical approaches can be used. Among these, minimally invasive surgery might be preferred. Myomectomy is the standard surgical treatment when fertility sparing is claimed. It can be performed via laparoscopy, robotic surgery and hysteroscopy and the choice depend on UFs features and surgeon's skill. Alongside these minimally invasive options, mini-laparotomy has been proposed as a less invasive surgical approach comparable to the well-established minimally invasive options. The aim of this review is to describe the most recent advances in minimally invasive techniques to perform myomectomy, comparing them with mini-laparotomy approach.
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Affiliation(s)
- Alejandro Marín-Buck
- Department of Surgery, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.,Department of Gynecology, Hospital Provincial de Castellón, Castellón, Spain
| | - Erbil Karaman
- Department of Obstetrics and Gynecology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Juan J Amer-Cuenca
- Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Juan F Lisón
- Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Carlos III Health Institute, Madrid, Spain
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, Debrecen, Hungary
| | - Onur Karaaslan
- Department of Obstetrics and Gynecology, Yuzuncu Yil University Medical Faculty, Van, Turkey
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Gabriella Zito
- Department of Obstetrics and Gynecology, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Benito Chiofalo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
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18
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Mallick R, Oxley S, Odejinmi F. The Use of Ulipristal Acetate (Esmya) Prior to Laparoscopic Myomectomy: Help or Hindrance? Gynecol Minim Invasive Ther 2019; 8:62-66. [PMID: 31143625 PMCID: PMC6515756 DOI: 10.4103/gmit.gmit_79_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/13/2018] [Accepted: 12/24/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: The aim of this study was to assess the operative effects, both positive and negative, of pretreatment with ulipristal acetate (UPA) on laparoscopic myomectomy. Materials and Methods: We conducted a retrospective analysis of prospectively collected data from patients who underwent a laparoscopic myomectomy over a 2-year period. Results: A total of 62 patients were included, of which 10 received a 3-month preoperative course of UPA, and 52 patients received no pretreatment. There was no statistically significant difference between the two groups (no pretreatment vs. UPA pretreatment) with regard to blood loss (214.4 [±214.96] vs. 160 [±51.64], P = 0.432), operating time (111.64 [±41.8] vs. 117.5 [±50.4], P = 0.694), and duration of inpatient stay (1.27 [±0.56] vs. 1.11 [±0.33], P = 0.419). There were no complications in either group. In 100% of cases with UPA pretreatment, a distortion of the fibroid capsule with a more technically challenging dissection was noted, compared to 0% in the no pretreatment group. This anatomical distortion may result in more cases of incomplete resection and a potentially higher risk of recurrence. Conclusion: We conclude that UPA confers no operative benefits and should be used with caution in the presurgical treatment of fibroids. The use of UPA may indeed result in a more technically difficult myomectomy with distorted cleavage planes and carry a potential risk of incomplete resection.
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Affiliation(s)
- Rebecca Mallick
- Department of Obstetrics and Gynaecology, Brighton and Sussex University Hospitals NHS Trust, Princess Royal Hospital, Haywards Heath, England, UK
| | - Sam Oxley
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
| | - Funlayo Odejinmi
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, Whipps Cross Hospital, London, UK
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Important considerations for women in the late reproductive and perimenopausal years desiring myomectomy. Curr Opin Obstet Gynecol 2019; 31:285-291. [PMID: 31022080 DOI: 10.1097/gco.0000000000000551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review important considerations in the counseling and management of women over the age of 40 desiring a myomectomy for symptomatic fibroids. RECENT FINDINGS Women in the late reproductive and perimenopausal years may choose a myomectomy over a hysterectomy for reasons of fertility preservation or a personal desire to retain their uterus. Data suggest that laparoscopic myomectomy is a low-risk procedure that can be offered to older women, though the age-related risk of uterine malignancy must be evaluated. SUMMARY When assessing the surgical candidacy of older women desiring myomectomy, it is important to weigh a woman's fertility potential, surgical risk, and concerns about malignancy with her desire to preserve the uterus and autonomy to choose a procedure type.
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20
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Torrent-Colomer A, Reyes Claret A, Vicens-Vidal M, Martin Jiménez A. Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2016.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Torrent-Colomer
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Albert Reyes Claret
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Margalida Vicens-Vidal
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Angel Martin Jiménez
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
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Fava V, Gremeau AS, Pouly JL, Chauvet P, Gałczyński K, Botchorishvili R, Bourdel N. Laparoscopic Myomectomy in 10 Steps. J Minim Invasive Gynecol 2019; 26:1009-1010. [PMID: 30639723 DOI: 10.1016/j.jmig.2018.12.021] [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] [Received: 10/24/2018] [Revised: 11/14/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Laparoscopic myomectomy has the advantages of a minimally invasive approach for the surgical treatment of myomas. The standardization and description of the technique are the main objectives of this video. We described laparoscopic myomectomy in 10 steps, which could help make this procedure easier and safer [1]. SETTING A French university tertiary care hospital. PATIENTS Patients with indication for laparoscopic myomectomy. The local institutional review board ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case. INTERVENTION Standardized laparoscopic myomectomies were recorded to realize the video. MEASUREMENTS AND MAIN RESULTS This video presents a systematic approach to myomectomy clearly divided into 10 steps: (1) prepare your surgery, make selection and prehabilitation of patient [2], provide a good cartography of the myoma(s), and plan the surgery [3,4]; (2) ergonomy and material; (3) preventive hemostasis: triple occlusion; (4) hysterotomy; (5) enucleation by fast dissection and traction; (6) bipolar hemostasis; (7) check for missing myomas; (8) suture; (9) extraction/morcellation; and (10) prevent adhesions [5]. CONCLUSION Standardization of laparoscopic myomectomy could make this procedure easier and safer to perform. The 10 steps presented help to perform each part of surgery in logical sequence making the procedure ergonomic and easier to adopt and learn. Standardization of laparoscopic techniques could help to reduce the learning curve.
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Affiliation(s)
- Valentina Fava
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel); Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy (Dr. Fava)
| | - Anne-Sophie Gremeau
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel)
| | - Jean Luc Pouly
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel)
| | - Pauline Chauvet
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel)
| | - Krzysztof Gałczyński
- Siedlce University of Natural Sciences and Humanities, Siedlce, Poland (Dr. Gałczyński); Second Department of Gynaecological Oncology, St John's of Dukla Cancer Centre of Lublin, Lublin, Poland (Dr. Gałczyński)
| | - Revaz Botchorishvili
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel)
| | - Nicolas Bourdel
- Department of Gynecological Surgery, CHU Estaing, Clermont-Ferrand, France (Drs. Fava, Gremeau, Pouly, Chauvet, Botchorishvili, and Bourdel).
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22
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Perioperative Outcomes of Myomectomy for Extreme Myoma Burden: Comparison of Surgical Approaches. J Minim Invasive Gynecol 2018; 26:1095-1103. [PMID: 30391510 DOI: 10.1016/j.jmig.2018.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/26/2018] [Accepted: 10/30/2018] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE To describe the perioperative outcomes of various modes of myomectomy (abdominal [AM], laparoscopic [LM], or robotic [RM]) in cases of extreme myoma burden. DESIGN Retrospective cohort study (Canadian Task Force classification II-2). SETTING A tertiary academic center in Boston, Massachusetts. PATIENTS All women who underwent an AM, LM, or RM for extreme myoma burden, defined as representing the upper quartile for specimen weight (≥434.6 g) or myoma count (≥7 myomas), between 2009 and 2016. INTERVENTIONS Baseline demographics and perioperative outcomes were collected from review of medical records, including estimated blood loss, operative time, length of stay, and complications. Univariate linear and logistic regression analyses were conducted. MEASUREMENTS AND MAIN RESULTS During the study period 659 women underwent myomectomy for extreme myoma burden; 47.2% of cases were AM, 28.1% LM, and 24.7% RM. Overall myoma burden differed across the 3 routes and was greatest in the AM group (mean weight: 696.2 ± 784.5 g for AM vs 586.6 ± 426.1 g for LM and 586.6 ± 426.1 g for RM; mean number: 16.8 ± 15.0 for AM vs 7.2 ± 7.0 for LM and 6.7 ± 4.7 for RM; p <.001 for both). The 3 routes differed in operative time and length of stay, with RM having the longest operative time (mean, 239.7 minutes; p <.001) and AM the longest length of stay (mean, 2.2 ± .9 days; p <.001). Other perioperative outcomes were similar across the surgical approaches. Increasing myoma burden was associated with an increased risk of perioperative complications for all surgical approaches, with a threshold of 13 myomas associated with an almost 2-fold higher risk of perioperative complications (odds ratio, 1.77; 95% confidence interval, 1.17-2.70; p = .009). Cumulative incidence of perioperative complications with increasing specimen weight was greater in the RM cases as compared with AM (p = .002) or LM (p = .020), whereas the cumulative incidence of perioperative complications with increasing myoma count was lowest with AM compared with LM (p <.001) or RM (p <.001). CONCLUSION Myomectomy for extreme myomas is feasible using an abdominal, laparoscopic, or robotic approach. Increased myoma burden is associated with an increased risk of perioperative complications. A threshold of 13 myomas was associated with an almost 2-fold higher risk of perioperative complications for all modes. Perioperative complication outcomes were more favorable in AM or LM over RM with increased myoma weight and AM over LM or RM with increased myoma number.
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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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Baba A, Sugiyama J, Sanpei Y, Kawakami R, Ashida H, Igarashi T, Munetomo Y, Yamazoe S, Kobashi Y, Mogami T, Takamatsu K. MR imaging and clinical features associated with intraoperative hemorrhage during laparoscopic myomectomy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Mirowska-Allen KL, Kong KKY, Ang WC. Unplanned hysterectomy following myomectomy at a tertiary institution: A case series and review of the literature. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518783664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Myomectomy is the gold standard uterine-sparing treatment for fibroids. However, the procedure is often complicated by blood loss. In rare cases, haemorrhage may be so severe that a conversion to hysterectomy is warranted. The aim of our study was to investigate the rates of and the clinical reasoning behind unplanned hysterectomies following attempted myomectomies at our institution. Methods: All patients who underwent an open or laparoscopic myomectomy at the Royal Women’s Hospital were identified using a gynaecology unit database, maintained from January 2004 to December 2013. Records for patients whose surgeries were unexpectedly converted to a hysterectomy were examined. A review of the literature was also performed, investigating the rates of unplanned hysterectomies following myomectomies. Results: Of the 1501 myomectomies performed, six resulted in an unplanned hysterectomy; an incidence rate of 0.4%. Fibroids were either intramural or pedunculated with the median number of tumours per patient being 2.5 (interquartile range: 1–6). The largest tumour for each patient varied significantly from 4.0 × 3.2 cm to 29.0 × 25.0 cm. In all cases, despite being strongly advised to have a planned hysterectomy, patients insisted on having a myomectomy. Two patients underwent conversion to hysterectomy intraoperatively while the remainder required a return to theatre. Difficulty achieving intraoperative haemostasis (n = 2), and the development of postoperative bleeding and coagulopathy (n = 4) were reasons cited for proceeding to hysterectomy. Conclusion: The rate of conversion from myomectomy to hysterectomy at our institution was low at 0.4%. In all cases, the reason for conversion was difficulty with haemostasis, despite infrequent use of haemostatic agents, and coagulopathy.
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Affiliation(s)
- Kelly L Mirowska-Allen
- The University of Melbourne, Parkville, VIC, Australia
- The Northern Hospital, Epping, VIC, Australia
| | - Karen KY Kong
- Gynaecology Department, The Royal Women’s Hospital, Parkville, VIC, Australia
| | - W Catarina Ang
- The University of Melbourne, Parkville, VIC, Australia
- Gynaecology Department, The Royal Women’s Hospital, Parkville, VIC, Australia
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Yang H, Li XC, Yao C, Lang JH, Jin HM, Xi MR, Wang G, Wang LW, Hao M, Ding Y, Chen J, Zhang JQ, Han L, Guo CX, Xue X, Li Y, Zheng JH, Cui MH, Li HF, Tao GS, Chen L, Wang SM, Lu AW, Huang ZH, Liu Q, Zhuang YL, Huang XH, Zhu GH, Huang OP, Hu LN, Li MJ, Zhou HL, Song JH, Zhu L. Proportion of Uterine Malignant Tumors in Patients with Laparoscopic Myomectomy: A National Multicenter Study in China. Chin Med J (Engl) 2018; 130:2661-2665. [PMID: 29133752 PMCID: PMC5695049 DOI: 10.4103/0366-6999.218008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma; therefore, the use of morcellation is limited in the USA. A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy. Methods: A national multicenter study was performed in China. From 2002 to 2014, 33,723 cases were retrospectively selected. We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application. A total of 62 cases were finally pathologically confirmed as malignant postoperatively. Additionally, the medical records of the 62 patients were analyzed in details. Results: The proportion of postoperative malignancy after morcellation application was 0.18% (62/33,723) for patients who underwent laparoscopic myomectomy. Nearly 62.9% (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery. And, 23 (37.1%) patients showed rapid growth at the final preoperative ultrasound. With respect to the pathological types, 38 (61.3%) patients had detectable endometrial stromal sarcoma, 13 (21.0%) had detectable uterine leiomyosarcoma, only 3 (3.2%) had detectable carcinosarcoma, and 5 (8.1%) patients with leiomyoma had an undetermined malignant potential. Conclusions: The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy. Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential, and morcellation should be avoided.
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Affiliation(s)
- Hua Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiao-Chuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Chen Yao
- Department of Biostatistics, Peking University Clinical Research Institute, Peking University First Hospital, Beijing 100871, China
| | - Jing-He Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
| | - Hang-Mei Jin
- Department of Obstetrics and Gynecology, Zhejiang University Affiliated Obstetrics and Gynecology Hospital, Zhejiang, Hangzhou 310006, China
| | - Ming-Rong Xi
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, Sichuan 610041, China
| | - Gang Wang
- Department of Obstetrics and Gynecology, The First People's Hospital of Foshan City, Foshan, Guangdong 528010, China
| | - Lu-Wen Wang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Henan Province, Zhengzhou, Henan 450052, China
| | - Min Hao
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Datong, Shanxi 030001, China
| | - Yan Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xinjiang Medical University, Urumchi, Xinjiang 830000, China
| | - Jie Chen
- Department of Obstetrics and Gynecology, People's Hospital of Fujian Province, Fuzhou, Fujian 350000, China
| | - Jian-Qing Zhang
- Department of Obstetrics and Gynecology, Qinghai Red Cross Hospital, Xining, Qinghai 810000, China
| | - Lu Han
- Department of Obstetrics and Gynecology, Dalian Maternity Hospital, Dalian, Liaoning 116021, China
| | - Cheng-Xiu Guo
- Department of Obstetrics and Gynecology, Tianjin Central Maternity Hospital, Tianjin 300100, China
| | - Xiang Xue
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
| | - Yan Li
- Department of Obstetrics and Gynecology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750003, China
| | - Jian-Hua Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150007, China
| | - Man-Hua Cui
- Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Huai-Fang Li
- Department of Obstetrics and Gynecology, Shanghai Tongji Hospital, Shanghai 200065, China
| | - Guang-Shi Tao
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410008, China
| | - Long Chen
- Department of Obstetrics and Gynecology, Qingdao Municipal Hospital, Qingdao, Shandong 266011, China
| | - Su-Min Wang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Nanjing, Nanjing, Jiangsu 210004, China
| | - An-Wei Lu
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guiyang City, Guiyang, Guizhou 550001, China
| | - Ze-Hua Huang
- Department of Obstetrics and Gynecology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Qing Liu
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Gansu Province, Lanzhou, Gansu 730050, China
| | - Ya-Li Zhuang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Anhui Province, Hefei, Anhui 230011, China
| | - Xiang-Hua Huang
- Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050073, China
| | - Gen-Hai Zhu
- Department of Obstetrics and Gynecology, Hainan Provincial People's Hospital, Haikou, Hainan 570311, China
| | - Ou-Ping Huang
- Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Jiangxi Province, Nanchang, Jiangxi 330006, China
| | - Li-Na Hu
- Department of Obstetrics and Gynecology, The Second Hospital Affiliated to Chongqing Medical University, Chongqing 400010, China
| | - Mu-Jun Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, China
| | - Hong-Lin Zhou
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Jing-Hui Song
- Department of Obstetrics and Gynecology, Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia Autonomous Region 010050, China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing 100730, China
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Martinez MEG, Domingo MVC. Size, Type, and Location of Myoma as Predictors for Successful Laparoscopic Myomectomy: A Tertiary Government Hospital Experience. Gynecol Minim Invasive Ther 2018; 7:61-65. [PMID: 30254939 PMCID: PMC6113999 DOI: 10.4103/gmit.gmit_12_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM. Methodology: Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed. Results: There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010). Conclusion: LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.
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Affiliation(s)
- Mikaela Erlinda G Martinez
- Department of Obstetrics and Gynecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Madonna Victoria C Domingo
- Department of Obstetrics and Gynecology, University of the Philippines, Philippine General Hospital, Manila, Philippines
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Havryliuk Y, Setton R, Carlow JJ, Shaktman BD. Symptomatic Fibroid Management: Systematic Review of the Literature. JSLS 2018; 21:JSLS.2017.00041. [PMID: 28951653 PMCID: PMC5600131 DOI: 10.4293/jsls.2017.00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives: Symptomatic uterine fibroids are a societal and healthcare burden with no clear consensus among medical professionals as to which procedural treatment is most appropriate for each symptomatic patient. Our purpose was to determine whether recommendations can be made regarding best practice based on review and analysis of the literature since 2006. Database: A systematic search of journal articles relevant to the treatment of symptomatic uterine fibroids was performed within PubMed, clinical society websites, and medical device manufacturers' websites. All clinical trials published in English, representing original research, and reporting clinical outcomes associated with interventions for the management of symptomatic uterine fibroids were considered. Each article was screened and selected based on study type, content, relevance, American College of Obstetricians and Gynecologists score, and internal/external validity. Outcomes of interest were patient baseline characteristics, fibroid characteristics, procedural details, complications, and long-term follow-up. Random-effects meta-analyses were used to test the quantitative data. Assessment of 143 full-length articles through January 2016 produced 45 articles for the quantitative analysis. The weighted combined results from hysterectomy trials were compared with those from uterine-preserving fibroid studies (myomectomy, uterine artery embolization, laparoscopic radiofrequency ablation, and magnetic resonance-guided focused ultrasound). Conclusion: We explored trends that might guide clinicians when counseling patients who need treatment of symptomatic fibroids. We found that fibroid therapy is trending toward uterine-conserving treatments and outcomes are comparable across those treatments. Since minimally invasive options are increasing, it is important for the clinician to provide the patient with evidence-based therapeutic strategies.
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Affiliation(s)
- Yelena Havryliuk
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | - Robert Setton
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
| | | | - Barry D Shaktman
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York, USA
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Wright K, Louie M, Siedhoff M. Hemostasis Techniques in Myomectomies. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2018. [DOI: 10.1007/s13669-018-0236-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Reintervention risk and quality of life outcomes after uterine-sparing interventions for fibroids: a systematic review and meta-analysis. Fertil Steril 2018; 109:698-707.e1. [DOI: 10.1016/j.fertnstert.2017.11.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/27/2017] [Accepted: 11/27/2017] [Indexed: 12/23/2022]
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Fayez I, Khreisat B, Athamneh T, Omoosh R, Daibes MA. Multiple Bilateral Ovarian Mature Cystic Teratomas with Ovarian Torsion: A Case Report. Oman Med J 2018; 33:163-166. [PMID: 29657687 DOI: 10.5001/omj.2018.30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ovarian tumors are a common form of neoplasm in women. Mature cystic teratoma is the most common type, with a bilateral incidence of 8-15%. However, few cases are reported as bilateral and multiple. A rare case of bilateral multiple dermoid cysts in a 19-year-old female patient presented with abdominal pain of one-day duration. Her medical history was unremarkable. Ultrasonography showed multiple bilateral ovarian cystic masses. The patient underwent laparotomy. The masses were excised while preserving the remaining ovarian tissue. Histopathology confirmed the diagnosis of multiple mature cystic teratomas with no presence of malignant tissue.
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Affiliation(s)
- Iman Fayez
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
| | - Basel Khreisat
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
| | - Tarek Athamneh
- Department of Obstetrics and Gynecology, Prince Rashid Ibn Al-Hasan Hospital, Irbid, Jordan
| | - Reema Omoosh
- Department of Obstetrics and Gynecology, King Hussein Medical Center, Amman, Jordan
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Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and Management of Complications in Laparoscopic Myomectomy. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8250952. [PMID: 29693017 PMCID: PMC5859837 DOI: 10.1155/2018/8250952] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/04/2018] [Indexed: 11/18/2022]
Abstract
Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.
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Affiliation(s)
- V. Tanos
- University of Nicosia Medical School, Nicosia, Cyprus
- European Academy for Gynecological Surgery (Nicosia Branch), 55-57 Andrea Avraamidi St., Strovolos, 2024 Nicosia, Cyprus
- Aretaeio Hospital, Strovolos, Nicosia, Cyprus
| | - K. E. Berry
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - M. Frist
- St George's, University of London MBBS Programme at the University of Nicosia Medical School, Nicosia, Cyprus
| | - R. Campo
- European Society Gynaecological Endoscopy, Leuven, Belgium
- The European Academy for Gynecological Surgery, Leuven, Belgium
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - R. L. DeWilde
- European Society Gynaecological Endoscopy, Leuven, Belgium
- Cahir Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany
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Gingold JA, Gueye NA, Falcone T. Minimally Invasive Approaches to Myoma Management. J Minim Invasive Gynecol 2018; 25:237-250. [DOI: 10.1016/j.jmig.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Tanos V, Berry K. Benign and malignant pathology of the uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:12-30. [DOI: 10.1016/j.bpobgyn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
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Mallick R, Odejinmi F. Pushing the boundaries of laparoscopic myomectomy: a comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre. ACTA ACUST UNITED AC 2017; 14:22. [PMID: 29200989 PMCID: PMC5684289 DOI: 10.1186/s10397-017-1025-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/01/2017] [Indexed: 11/24/2022]
Abstract
Background The aim of this study was to analyse the demographic data and peri-operative outcomes of women undergoing a laparoscopic myomectomy and assess what factors, if any, precluded using the laparoscopic approach. Methods A single surgeon observational study of 323 patients undergoing a laparoscopic myomectomy was undertaken. Data was collected prospectively over a 12-year period and analysed using SPSS. Surgical outcomes included operating time, estimated blood loss, conversion to laparotomy, intraoperative and postoperative complications and duration of inpatient stay. Results A total of 323 patients underwent a laparoscopic myomectomy over the 12-year period. The majority of fibroids removed were intramural (49%) and subserosal (33%). The mean size of fibroids removed was 7.66 ± 2.83 (7.34–7.99) cm, and the mean number was 4 ± 3.62 (3.6–4.39), with the greatest being 22 removed from a single patient. Average blood loss was 279.14 ± 221.10 (254.59–303.69) ml with mean duration of surgery and inpatient stay recorded as 112.92 ± 43.21 (107.94–117.91) min and 1.88 ± 0.95 (1.77–1.99) days, respectively. No major intraoperative complications were noted, and the conversion to laparotomy rate was 0.62%. All histology following morcellation was benign. Over the 12-year period despite increasingly large and more numerous fibroids being tackled, increasing experience resulted in a simultaneous reduction in overall blood loss, operating time and duration of inpatient stay. Conclusions Laparoscopic myomectomy is a safe and efficacious procedure that should be considered the gold standard surgical treatment option for fibroids. With experience, the procedure can be undertaken with minimal complications, a low risk of conversion to laparotomy and early discharge from hospital, even in cases of large and multiple fibroids that historically would have required the open approach. This allows even the most complex of cases to now benefit for the advantages of the minimal access approach.
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Affiliation(s)
- Rebecca Mallick
- Department of Gynaecology, Barts Health NHS Trust, Whipps Cross University Hospital, London, E11 1NR UK
| | - Funlayo Odejinmi
- Department of Gynaecology, Barts Health NHS Trust, Whipps Cross University Hospital, London, E11 1NR UK
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Prevalence of undiagnosed uterine leiomyosarcoma in women undergoing hysterectomy or myomectomy for benign indications. Eur J Obstet Gynecol Reprod Biol 2017; 216:239-244. [DOI: 10.1016/j.ejogrb.2017.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 02/07/2023]
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Mynbaev OA, Malvasi A, Simakov SS, Tinelli A. Comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation". Reprod Biol Endocrinol 2017; 15:54. [PMID: 28732545 PMCID: PMC5521111 DOI: 10.1186/s12958-017-0268-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cause of contamination and dissemination of leiomyoma tissue particles and cells in the peritoneal cavity during myomectomy is a challenging issue for both clinicians and researchers. Therefore, the article by Huang et al. recently published in your journal is the subject of this letter. MAIN BODY We comment on the role of laparoscopic condition in xenograft implantation and also highlighted the shortcomings of this study. The surgical technique of intramural fibroid enucleation, cell spillage during morcellation and postsurgical hormonal impact on the development of parasitic myomas become evident, while the contribution of CO2 insufflation, the fibroid's nature, mutations and pseudocapsule impacts on angiogenesis are not clear. In addition, an exploration of the exact origin of implanted fragments harvested from the fibroid tissue and their nature might play a significant role in the implantation and the angiogenesis induction ability of xenografts. CONCLUSION Taking into account the current literature in the scope of this study, we suggest that the factors involved in development of parasitic myomas can be classified as confirmed and doubtful contributions.
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Affiliation(s)
- Ospan A. Mynbaev
- 0000 0000 9559 0613grid.78028.35Division of Molecular Technologies, Research Institute of Translational Medicine, N.I.Pirogov Russian National Research Medical University, Ostrovitianova str. 1, Moscow, 117997 Russia
- 0000 0001 2192 9124grid.4886.2Institute of Numerical Mathematics, RAS, Moscow, Russia
| | - Antonio Malvasi
- 0000 0004 1785 3878grid.415208.aDepartment of Obstetrics and Gynecology, Santa Maria Hospital. G.V.M. Care and Research, Bari, Italy
| | - Sergei S. Simakov
- 0000 0001 2192 9124grid.4886.2Institute of Numerical Mathematics, RAS, Moscow, Russia
| | - Andrea Tinelli
- 0000 0004 1769 6825grid.417011.2Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, Lecce, Italy
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Sarcoma Risk in Uterine Surgery in a Tertiary University Hospital in Germany. Int J Gynecol Cancer 2017; 27:961-966. [DOI: 10.1097/igc.0000000000000988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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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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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Lee SW, Park EK, Lee SJ, Lee KH. Comparison study of consecutive 100 cases of single port vs. multiport laparoscopic myomectomy; technical point of view. J OBSTET GYNAECOL 2017; 37:616-621. [PMID: 28393585 DOI: 10.1080/01443615.2017.1281896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We report our experience with single-port and multiple-port laparoscopic myomectomy with operative outcomes and surgical skills. Hundred consecutive patients underwent single-port laparoscopic myomectomy (SP-LM) and 69 multi-port laparoscopic myomectomy (MP-LM). The operative outcomes were compared between the two methods. All procedures were successfully completed without conversion to abdominal myomectomy. The mean maximum diameter of the largest myoma was 7.4 (5-13) vs. 6.8 (5-12) cm and the mean number of myomas was 1.7 vs. 1.6 in SP-LM and MP-LM group, respectively. Mean operative time was 134.2 vs. 122.9 min in SP-LM and MP-LM group (p = .109). We showed that SPL myomectomy is a safe and feasible technique compared to MPL myomectomy with respect to postoperative pain, mean operating time, mean estimated blood loss and length of stay. To improve suturing technique of SP-LM, the working instruments were placed external to the telescope with 'micro-triangulation'.
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Affiliation(s)
- Suk Woo Lee
- a Department of Obstetrics and Gynecology , Hallym University Sacred Heart Hospital, Hallym University College of Medicine , Anyang , Korea
| | - Eun Kyung Park
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
| | - Sung Jong Lee
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
| | - Keun Ho Lee
- b Department of Obstetrics and Gynecology , The Catholic University of Korea , Seoul , Korea
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Bean EMR, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients. J Minim Invasive Gynecol 2017; 24:485-493. [DOI: 10.1016/j.jmig.2017.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 11/26/2022]
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Chen KH, Seow KM, Chen LR. Uterine Suspension With Adjustable Sutures for Difficult Laparoscopic Myomectomy. J Minim Invasive Gynecol 2017; 24:264-271. [DOI: 10.1016/j.jmig.2016.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
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Arian SE, Munoz JL, Kim S, Falcone T. Robot-assisted laparoscopic myomectomy: current status. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:7-18. [PMID: 30697559 PMCID: PMC6193424 DOI: 10.2147/rsrr.s102743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.
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Affiliation(s)
- Sara E Arian
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Jessian L Munoz
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Suejin Kim
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
| | - Tommaso Falcone
- Department of Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA,
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Vargas MV, Moawad GN, Sievers C, Opoku-Anane J, Marfori CQ, Tyan P, Robinson JK. Feasibility, Safety, and Prediction of Complications for Minimally Invasive Myomectomy in Women With Large and Numerous Myomata. J Minim Invasive Gynecol 2016; 24:315-322. [PMID: 27939896 DOI: 10.1016/j.jmig.2016.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/04/2016] [Accepted: 11/30/2016] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess perioperative outcomes and identify predictors of complications for minimally invasive surgery (MIS) myomectomy in a cohort of women with large and numerous myomata. DESIGN Case-control study (Canadian Task Force classification II-2). SETTING Academic tertiary care medical center. PATIENTS Women undergoing MIS myomectomy performed by 3 high-volume surgeons between April 2011 and December 2014. INTERVENTIONS Characteristics were compared between women who experienced complications and those who did not. Factors predictive of complications were then identified. MEASUREMENTS AND MAIN RESULTS A total of 221 women underwent an MIS myomectomy, 47.5% via a laparoscopic approach and 52.5% via robotic surgery. The mean ± SD specimen weight was 408.1 ± 384.9 g, uterine volume was 586.1 ± 534.1 cm3, dominant myoma diameter was 9.6 ± 5.1 cm, and number of myomata removed was 4.5 ± 4.1. The most common complications were hemorrhage >1000 mL (8.6%) and blood transfusion (4.1%). The conversion rate was 1.8%. A dominant myoma diameter of ≥12 cm and a uterine volume of ≥750 cm3 increased the odds of complications (odds ratio [OR], 7.44; 95% confidence interval [CI], 2.03-31.84; p = .004 and OR, 6.15; 95% CI, 1.55-30.02; p = .014 respectively). A receiver operating characteristic curve considering dominant myoma diameter and uterine volume had an area under the curve of 0.81. A combination of dominant myoma diameter of ≥10 cm and uterine volume of 600 cm3 predicted complications with 79% sensitivity and 79% specificity. CONCLUSION Our cohort had large and numerous myomata with high specimen weights, but complications were comparable to those reported in previous studies of MIS myomectomy with less complex pathology. Hemorrhage and transfusion accounted for the majority of complications, and a combination of dominant myoma diameter and uterine volume was predictive of complications. Both factors can be easily defined before surgery and may be used to guide patient counseling, referrals, and implementation of preventative measures for hemorrhage and transfusion.
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Affiliation(s)
- Maria V Vargas
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Cem Sievers
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Jessica Opoku-Anane
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Cherie Q Marfori
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Paul Tyan
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James K Robinson
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
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Huang BS, Yang MH, Wang PH, Li HY, Chou TY, Chen YJ. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016; 14:64. [PMID: 27716434 PMCID: PMC5053344 DOI: 10.1186/s12958-016-0200-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
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Affiliation(s)
- Ben-Shian Huang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.169, Siaoshe Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Hsin-Yang Li
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
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Lete I, González J, Ugarte L, Barbadillo N, Lapuente O, Álvarez-Sala J. Parasitic leiomyomas: a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 203:250-9. [PMID: 27359081 DOI: 10.1016/j.ejogrb.2016.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/27/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Parasitic leiomyomas were first described as early as 1909 but are a rare condition. In recent years, due to the rise of laparoscopic surgery and power morcellation, several cases of parasitic leiomyomas associated with this surgical procedure have been reported. METHODS A literature search was performed using PubMed, Embase and Google Scholar with the following combination of keywords: leiomyoma OR uterine neoplasms OR uterine myomectomy OR laparoscopy OR hysterectomy OR peritoneal neoplasms AND parasitic. Papers describing parasitic leiomyomas were included. The results of these studies are summarized herein. RESULTS We retrieved abstracts of 756 papers. Of these, 591 were excluded for not fulfilling the inclusion criteria and 54 were removed as duplicates; after full-text assessment, 8 were rejected for presenting cases of malignancy and finally 103 were included in our systematic review. From these, we present information about 274 patients with parasitic leiomyomas. The mean age of women was 40 years (range 18-79 years); and 154 (56%) had no history of uterine surgery, the others (120, 44%) having had a previous myomectomy or hysterectomy. Of the total, 106 (39%) women had a history of power morcellation. The most frequent clinical symptom was abdominal pain (49%) and the most frequent presentation was disseminated peritoneal leiomyomatosis. CONCLUSIONS While parasitic leiomyoma was first described a century ago, the recent introduction of laparoscopic power morcellation has increased the number of reported cases.
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Affiliation(s)
- Iñaki Lete
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain; School of Medicine, Basque Country University, Vitoria, Spain; BioAraba Research Unit, Vitoria, Spain.
| | - Janire González
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Lorea Ugarte
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Nagore Barbadillo
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Oihane Lapuente
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
| | - Javier Álvarez-Sala
- Department of Obstetrics and Gynecology, University Hospital Araba, Vitoria, Spain
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Dixit N, Jesner O, Modarres M. Endoscopic Treatment and Power Morcellation of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0155-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yuk JS, Kim LY, Kim SH, Lee JH. The Incidence of Unexpected Uterine Malignancy in Women Undergoing Hysterectomy for a Benign Condition: A National Population-Based Study. Ann Surg Oncol 2016; 23:4029-4034. [DOI: 10.1245/s10434-016-5287-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Indexed: 11/18/2022]
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Augmented reality in gynecologic surgery: evaluation of potential benefits for myomectomy in an experimental uterine model. Surg Endosc 2016; 31:456-461. [DOI: 10.1007/s00464-016-4932-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
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