Timing for a Laparoscopic Myomectomy During the Menstrual Cycle

Three-dimensional versus two-dimensional laparoscopic myomectomy: A randomized controlled trial

OBJECTIVE

This study aimed to compare the surgical outcomes of three-dimensional (3D) and two-dimensional (2D) laparoscopic myomectomy.

STUDY DESIGN

A total of 64 patients with symptomatic uterine fibroids were randomly assigned to either the 3D (n = 32) group or the 2D group (n = 32). The primary outcomes were the operative blood loss and change in hemoglobin levels. The secondary outcome was operative time.

RESULTS

There were no differences in the baseline demographics between the two groups. The 3D and 2D groups were not significantly different in terms of operative blood loss (129.5 ± 86.5 mL vs. 140.9 ± 89.8 mL, P = 0.412), change in serum hemoglobin levels (1.4 ± 1.6 g/dL vs. 1.6 ± 1.6 g/dL, P = 0.553), and operative time (77.4 ± 37.8 min vs. 82.4 ± 35.4 min, P = 0.344). Furthermore, no differences were observed between the groups with regard to other surgical outcomes.

CONCLUSION

The 3D imaging system had no additional surgical benefit in laparoscopic myomectomy compared with to the conventional 2D imaging system.

Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle

PURPOSE

To investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle.

MATERIALS AND METHODS

In this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33-52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups.

RESULTS

A 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups.

CONCLUSIONS

The present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.

The menstrual cycle and blood loss during laparoscopic myomectomy

INTRODUCTION

Operative morbidity of laparoscopic myomectomy largely relates to the potential for intraoperative blood loss. We sought to determine whether blood loss varies according to the menstrual cycle.

MATERIAL AND METHODS

A retrospective study of 268 women who underwent a laparoscopic myomectomy from 2007 to 2012. Patients were categorized into five menstrual groups: follicular phase, luteal phase, oligomenorrheic or amenorrheic on hormonal therapy, postmenopausal or other. Patient and procedure characteristics were compared for the follicular phase group, luteal phase group, and hormonal therapy group. The estimated blood loss was compared across the five groups using a regression model.

RESULTS

A total of 268 women underwent a laparoscopic myomectomy: 108 (40.3%) were in the follicular phase, 92 (34.3%) were in the luteal phase, 44 (16.4%) were on hormonal therapy, nine (3.4%) were postmenopausal, and 15 (5.6%) could not be classified. Baseline patient characteristics were similar between the groups with the exception of endometriosis. Geometric mean estimated blood loss was 91.9 mL in the follicular phase group, 108.7 mL in the luteal phase group, 114.1 mL in the hormonal therapy group, and 39.8 mL in the postmenopausal group. There was no significant difference in the geometric mean estimated blood loss when comparing the follilcuar phase, luteal phase, and hormonal phase groups (p = 0.41). Upon adjusted multivariable analysis of all five menstrual groups, there was also no difference in estimated blood loss.

CONCLUSIONS

Intraoperative blood loss during laparoscopic myomectomy does not vary significantly with the phase of the menstrual cycle.