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Lim ET, Kostic A, Tsampras N. Laparoscopic myomectomy for a large uterine fibroid: A video case report. Eur J Obstet Gynecol Reprod Biol 2024; 300:347-348. [PMID: 39079855 DOI: 10.1016/j.ejogrb.2024.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/15/2024] [Accepted: 07/21/2024] [Indexed: 08/26/2024]
Affiliation(s)
- Ee Thong Lim
- Manchester University NHS Foundation Trust, United Kingdom.
| | - Andras Kostic
- Manchester University NHS Foundation Trust, United Kingdom
| | - Nikolaos Tsampras
- Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, United Kingdom
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Kathopoulis N, Prodromidou A, Douligeris A, Diakosavvas M, Zacharakis D, Kypriotis K, Chatzipapas I, Grigoriadis T, Protopapas A. Barbed Sutures Compared With Conventional Sutures During Laparoscopic Myomectomy: A Systematic Review and Meta-analysis. Obstet Gynecol 2024:00006250-990000000-01131. [PMID: 39146537 DOI: 10.1097/aog.0000000000005695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To accumulate the currently available literature on the safety and efficacy of the use of knotless barbed sutures for the reconstruction of the uterine wall during laparoscopic myomectomy based on comparison with traditional suture studies. DATA SOURCES We searched PubMed/Medline, Scopus, ClinicalTrials.gov, and Google Scholar up to February 29, 2024. METHODS OF STUDY SELECTION Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and PICO criteria, we included all English-language, full-text articles that evaluated the perioperative outcomes of patients who had laparoscopic myomectomy and repair of the uterine wall defect with either barbed or traditional (extracorporeal or intracorporeal sutures). TABULATION, INTEGRATION, AND RESULTS The application of barbed sutures resulted in significantly reduced operative time (2,111 patients, mean difference -12.04 minutes, 95% CI, -16.94 to -7.14, P<.001). This was also reflected when suturing time was separately analyzed (437 patients, mean difference -6.04 minutes, 95% CI, -7.43 to -4.65, P<.001) The mean difference in hemoglobin levels before and after surgery was significantly lower in the barbed suture group (1,277 patients, mean difference -0.40 g/dL, 95% CI, -0.72 to -0.09, P<.01) This was also observed in case of estimated blood loss, which was found to be lower in the barbed suture group (1,823 patients, mean difference -47.22 mL, 95% CI, -78.54 to -15.90, P=.003). Finally, the barbed suture group presented lower transfusion rates (1,217 patients, odds ratio 0.43, 95% CI, 0.19-1.00, P=.05). Concerning visual analog scale (VAS) score as evaluated by the surgeons for surgical difficulty, the control group proved to be more technically challenging compared with the barbed sutures group (184 patients, mean difference -1.66 95% CI, -2.37 to -0.94, P<.001). The VAS score for pain at 24 hours postoperatively, postoperative complication rates, and length of hospital stay were similar for both groups. Regarding reproductive outcomes, there was no difference in pregnancy, live birth, and birth complication rates. CONCLUSION The use of barbed sutures during laparoscopic myomectomy presents many clinical benefits for the patient and the surgeon in terms of shorter operative and suturing time, less estimated blood loss, and ease of use. This pioneer technology may contribute to the expansion of laparoscopy on more complex myomectomies. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42023477304.
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Affiliation(s)
- Nikolaos Kathopoulis
- 1st Department of Obstetrics and Gynecology, University of Athens, Alexandra Hospital, Athens, Greece
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Advincula AP. Robot-assisted laparoscopic myomectomy: Technique & brief literature review. Best Pract Res Clin Obstet Gynaecol 2024; 93:102452. [PMID: 38359581 DOI: 10.1016/j.bpobgyn.2023.102452] [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: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
The worldwide growth of robot-assisted laparoscopic surgery has been exponential since its FDA approval for use in gynecologic surgery in the spring of 2005. This growth has spanned the entire gamut of gynecologic procedures and pathology. One area that has leveraged the unique aspects of robotics has been its application to the conservative surgical management of uterine fibroids. This manuscript will review the surgical technique and highlight the current situation regarding the scientific literature with an evidence-based focus on the role of robot-assisted laparoscopic myomectomy (RALM) with the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA).
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Affiliation(s)
- Arnold P Advincula
- Department of Obstetrics & Gynecology, Chief of Gynecologic Specialty Surgery, Sloane Hospital for Women, Columbia University Medical Center/New York-Presbyterian Hospital, 622 W 168th St, PH 16, Rm 139, New York, NY, 10032, USA.
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Balulescu L, Nistor S, Lungeanu D, Brasoveanu S, Pirtea M, Secosan C, Grigoras D, Caprariu R, Pasquini A, Pirtea L. Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery. Front Med (Lausanne) 2023; 10:1216455. [PMID: 37675138 PMCID: PMC10477596 DOI: 10.3389/fmed.2023.1216455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. Materials and methods This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: "LM + TOHA" group (29 patients), and "LM" group (31 patients). The study's main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). Results Delta Hb was statistically lower in the "LM + TOHA" group compared to "LM" group, with mean ± standard (min-max): 1.68 ± 0.67 (0.39-3.99) vs. 2.63 ± 1.06 (0.83-4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the "LM" group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in "LM + TOHA" group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7-15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. Discussion Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. Clinical trial registration ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.
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Affiliation(s)
- Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Samuel Nistor
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Radu Caprariu
- Department of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Pasquini
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- “Pius Brinzeu” County Clinical Emergency Hospital, Timisoara, Romania
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
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Liao S, Wang X, Fu N, Huang Y. High-intensity focussed ultrasound and hysteroscopy endo-operative system cold device procedures for treating >4cm diameter FIGO Type 2 uterine myoma and ensuring successful pregnancy. EUR J CONTRACEP REPR 2023:1-4. [PMID: 37267044 DOI: 10.1080/13625187.2023.2216329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE Laparotomic or hysteroscopic myomectomy, and high-intensity focussed ultrasound (HIFU), can be used in the treatment of Type 2 myomas with a > 50% intramural component. Hysteroscopic electroresection may damage the remaining endometrium and complete ablation of myomas may not be realised via HIFU treatment. We report and examine the results of 1 case of HIFU treatment, accompanied with the hysteroscopy endo-operative system (HEOS) cold device procedure. MATERIALS AND METHODS These were used for treating a > 4cm diameter Type 2 uterine myoma and ensuring successful pregnancy. HIFU treatment of uterine myomas can achieve point-by-point ablation of lesions as far as possible without damaging the endometrium. The HEOS cold device procedure was implemented 3 months after HIFU treatment. RESULTS The patient got pregnant naturally in the third month after receiving treatment, with no complications during her pregnancy. The patient gave birth to a healthy male via full-term cesarean section. CONCLUSIONS HIFU treatment, accompanied with the HEOS cold device procedure, ensured complete myoma removal. It also preserved the integrity of the myometrium and prevented uterine perforation during surgery.
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Affiliation(s)
- Sha Liao
- Department of Operating Room Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xiaoli Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Fu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Huang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
- Department of Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Petrozza JC, Fitz V, Bhagavath B, Carugno J, Kwal J, Mikhail E, Nash M, Barakzai SK, Roque DR, Bregar AJ, Findley J, Neblett M, Flyckt R, Khan Z, Lindheim SR. Surgical approach to 4 different reproductive pathologies by 3 different gynecologic subspecialties: more similarities or differences? Fertil Steril 2023; 119:377-389. [PMID: 36574916 DOI: 10.1016/j.fertnstert.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Affiliation(s)
- John C Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bala Bhagavath
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Moawad Nash
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dario R Roque
- Division of Gynecologic Oncology, Feinberg School of Medicine, Northwestern University
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Michael Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, University of Central Florida, Orlando, Florida; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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The use of sealing hemostat patch (HEMOPATCH ®) in laparotomic myomectomy: a prospective case-control study. Arch Gynecol Obstet 2023; 307:1521-1528. [PMID: 36790464 DOI: 10.1007/s00404-023-06957-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Uterine myomas are the most common gynecological disease. In these cases, a myomectomy is performed traditionally laparotomically. However, alternatives have been widely used, including laparoscopic, endoscopic, and robotic surgery. During these techniques, diffuse parenchymatous bleeding remains one of the main intraoperative and postoperative complications and sometimes requires unplanned hysterectomies. Recently, hemostatic agents and sealants have been used to prevent excessive blood loss during surgical repair. METHODS We propose a prospective case-control study on the use of a sealing hemostat patch (HEMOPATCH®) on uterine sutures in laparotomic myomectomy. In the period between July 2016 and April 2017, 46 patients with symptomatic uterine fibromatosis underwent surgery. They were divided into two groups of 23 patients, with different treatments in the hemostatic phase of oozing bleeding. HEMOPATCH® is applied in group A, and spray electrocoagulation is applied in group B. RESULTS In group A, we achieve faster hemostasis (p < 0.05), than in group B. We report a significantly lower C-reactive protein value on the second and third days after surgery for group A compared to group B. CONCLUSIONS HEMOPATCH®, during laparotomic myomectomy, is a valid alternative solution for obtaining rapid hemostasis and consequently intraoperative and postoperative bleeding. Furthermore, we suggest that a lower inflammatory peritoneal state is probably correlated with the barrier effect of the patch on the suture.
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Yuan P, Bai C, Yu F, Ge Z, Wang M, Tan H. Reducing blood loss during laparoscopic myomectomy using a tourniquet loop around the lower uterine segment. Fertil Steril 2023; 119:333-335. [PMID: 36564265 DOI: 10.1016/j.fertnstert.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To present a simple and effective hemostatic technique using a tourniquet loop during laparoscopic myomectomy. DESIGN Pericervical tourniquet has been proven to be a safe and effective measure to reduce blood loss during open myomectomy. However, the use of a tourniquet in laparoscopic myomectomy has been rarely reported probably because the application is difficult and troublesome. In our technique, a prefabricated tourniquet loop, adapted from a Foley catheter, is applied around the lower segment of the uterus. It is easy to apply a tourniquet loop around the lower uterine segment during laparoscopic myomectomy. There is no need to make a window in the broad ligament to apply a pericervical tourniquet or triple tourniquets. Meanwhile, complete blockage of blood supply from the uterine artery and utero-ovarian anastomoses may ensure better hemostasis. SETTING A tertiary hospital. PATIENT(S) The patient was a 34-year-old woman with uterine leiomyoma and a desire for future fertility. She had been suffering from urinary frequency and chronic bladder pressure for the past 6 months. Magnetic resonance imaging confirmed 2 intramural masses measuring 96 mm × 91 mm and 25 mm × 13 mm at the anterior uterine wall. INTERVENTION(S) Institutional review board and ethics committee approval was obtained. Laparoscopic myomectomy was performed with the application of a tourniquet loop around the lower segment of the uterus (step-by-step video demonstration): homemade tourniquet loop formation using a 14-Fr latex Foley catheter; trocar placement with 2 umbilical ports (10 mm and 5 mm) and a 5-mm port at the lower-left quadrant of the abdomen; application of a tourniquet loop around the lower uterine segment; tumor enucleation and myometrial closure; removal of the tourniquet loop and a check for bleeding; contained specimen extraction via the merged umbilical incision; and inspection of the abdominal cavity and closure of the merged umbilical incision. MAIN OUTCOME MEASURE(S) Feasibility of using a tourniquet loop as an effective hemostatic technique in laparoscopic myomectomy. RESULT(S) The surgery lasted for approximately 90 minutes, and the tourniquet time was approximately half an hour. The estimated blood loss was only 20 mL. Her hemoglobin value on day 1 after the surgery was 131 g/L, the same as the preoperative level. Pathology confirmed the diagnosis of leiomyoma. The patient was discharged 2 days after the surgery with no complications. During follow-up, the patient reported that there was no discomfort and that her menses were normal. Her fallopian tubes were patent in the hysterosalpingogram. Her ovarian function, which was assessed by serum follicle-stimulating hormone concentration (5.34 mIU/mL) on day 3 of her menstrual cycle and antimüllerian hormone level (2.01ng/mL), was in the normal range. She was suggested to conceive 1 year after the procedure. CONCLUSION(S) Application of a tourniquet loop around the lower uterine segment is a simple and effective hemostatic technique during laparoscopic myomectomy. Randomized prospective studies are needed to determine the hemostatic effect of the laparoscopic use of a tourniquet loop and its impact on fertility and ovarian function.
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Affiliation(s)
- Peng Yuan
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China.
| | - Changmin Bai
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China
| | - Fan Yu
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China
| | - Zhonghu Ge
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China
| | - Mengyao Wang
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China
| | - Hongwei Tan
- Department of Gynecology, Northwest Women's and Children's Hospital (Shaanxi Provincial Maternity and Child Health Care Hospital), Xi'an, Shaanxi, People's Republic of China.
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Kuo HH, Lin WL, Pai AHY, Yen CF. Laparoscopic Triple-tourniquet Constriction: A Convenient Way for Minimizing Blood Loss during Myomectomy. J Minim Invasive Gynecol 2022; 29:1219-1220. [PMID: 36038062 DOI: 10.1016/j.jmig.2022.08.009] [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: 06/09/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
STUDY OBJECTIVE Although a pericervical tourniquet helped reduce blood loss in myomectomy [1], a technique of triple tourniquets was more influential in occluding the uterine vessel networks [2,3]. This video demonstrates the procedures of laparoscopic triple-tourniquet constriction with the number 1 suture around the uterine isthmic portion and bilateral infundibulopelvic ligaments [4] in a case of robotic myomectomy. DESIGN A step-by-step, narrated video demonstration. SETTING A university hospital. INTERVENTIONS Robotic myomectomy was scheduled for a patient with menorrhagia. Magnetic resonance imaging revealed 8 uterine myomas; the maximal one was 9.1 × 8.4 × 8.6 cm in dimension. Our robotic settings included 3 ports: fenestrated bipolar in the left lower quadrant, spatula or mega needle holder in the right lower quadrant, and an umbilical glove port accessible for lens and assisted instruments. A number 1 Monocryl (Ethicon, Bridgewater, NJ) was introduced from the suprapubic area extracorporeally; then, the needle penetrated through bilateral avascular zones of broad ligaments at the isthmic level and with a sliding tie made anteriorly to the uterus. The isthmic tourniquet-we also named it as the hangman's tourniquet-was tightened by manually tensioning the suture extracorporeally and pushing down the knot intracorporeally. Bilateral infundibulopelvic tourniquets were placed by using sliding ties of 1-0 Monocryl as well. With the total occlusion of uterine vessel networks, the uterus should retain only minimal blood flow. During the enucleation of uterine myomas, the tourniquet may loosen because of newly developed, unoccupied space with increasing bleeding; therefore, the tourniquet should be tightened up regularly throughout the surgery. After the repair of all the uterine wounds, we removed the 3 tourniquets. CONCLUSION The convenient and adjustable triple-tourniquet constriction is a safe and feasible laparoscopic technique to block the vessel networks temporally in uterine-preserving surgery.
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Affiliation(s)
- Hsin-Hong Kuo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan (all authors)
| | - Wei-Li Lin
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan (all authors)
| | - Angel Hsin-Yu Pai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan (all authors)
| | - Chih-Feng Yen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan (all authors); School of Medicine, National Tsing Hua University (Dr. Yen), Hsinchu, Taiwan.
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Akbaba E, Sezgin B, Sivaslıoğlu AA. Can the application of a temporary uterine tourniquet during an abdominal myomectomy reduce bleeding? J Turk Ger Gynecol Assoc 2022; 23:111-116. [PMID: 34100575 PMCID: PMC9161001 DOI: 10.4274/jtgga.galenos.2021.2020-0242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objective Uterine fibroids are common, benign uterine tumours. The three most common surgical treatment approaches for uterine fibroids are laparoscopic, robotic and abdominal myomectomies. Bleeding is a risk with all three approaches. The present study compared post-operative and pregnancy outcomes in patients with bilateral uterine artery occlusion who underwent an abdominal myomectomy, with or without a temporary uterine tourniquet. Material and Methods This retrospective study included patients with intra-mural fibroids (≥5 cm) who underwent an abdominal myomectomy. The patients were divided into two groups according to the use or non-use of a temporary uterine tourniquet. Post-operative and pregnancy outcomes in the tourniquet use and non-use groups were compared. The association of the number of uterine fibroids removed (≤3 vs >3) with laboratory parameters was also evaluated. Results A total of 84 patients were included, divided into use (n=36) and non-use (n=48) of the temporary tourniquet. There was a statistically significant difference between the groups with >3 myomas removed and with a uterine tourniquet applied and not applied in terms of reduction in hemoglobin and hematocrit, transfusion amounts, operation times and lengths of hospitalization in favour of the uterine tourniquet use group (p=0.019, p=0.023, p=0.012, p=0.044 and p=0.036, respectively). Bilateral uterine arterial occlusion using a temporary uterine tourniquet had no negative effects on pregnancy outcomes. Conclusion A temporary uterine tourniquet may be an effective method for reducing the amount of perioperative bleeding in patients with multiple, large-sized myomas located close to vascular structures.
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Affiliation(s)
- Eren Akbaba
- Department of Obstetrics and Gynecology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Burak Sezgin
- Department of Obstetrics and Gynecology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Ahmet Akın Sivaslıoğlu
- Department of Obstetrics and Gynecology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
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Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids. BMC Surg 2022; 22:175. [PMID: 35562739 PMCID: PMC9101931 DOI: 10.1186/s12893-022-01626-8] [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] [Received: 01/28/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background The most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion. Methods A retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05. Results There was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups. Conclusion Seromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.
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Delli Carpini G, Morini S, Tsiroglou D, Verdecchia V, Montanari M, Donati V, Giannella L, Burattini L, Giannubilo SR, Ciavattini A. Factors influencing intraoperative blood loss and hemoglobin drop during laparoscopic myomectomy: a tailored approach is possible? J OBSTET GYNAECOL 2021; 42:1404-1409. [PMID: 34918598 DOI: 10.1080/01443615.2021.1983782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A retrospective study was conducted on patients subjected to laparoscopic myomectomy at our institution from January 2017 to December 2018 to identify predictive factors of blood loss. Two multiple regression models were run to predict intraoperative blood loss and haemoglobin drop. Predictors of an increased intraoperative blood loss and haemoglobin drop were the presence of three-four fibroids at ultrasound (+47 ml, p = .01; +0.58 g/dl, p = .05) and increased operative time (r = 0.57, p = .01; r = 0.01, p < .01), while predictors of a reduced intraoperative blood loss and haemoglobin drop were epinephrine injection (-50 ml, p < .01; -0.42 g/dl, p < .01), FIGO7 (-87 ml, p < .01; -0.85, p = .01), and FIGO6 (-35 ml, p < .01; -0.44, p = .02) fibroids at the ultrasound. Preoperative ultrasound evaluation is crucial in identifying patients at higher risk for blood loss, which could benefit from optimising haemoglobin values. The injection of diluted epinephrine could be proposed in selected high-risk patients. In the clinical practice, a tailored approach based on fibroids' ultrasonographic characteristics should be implemented to optimise preoperative Hb values and evaluate the use of diluted epinephrine in selected cases, reducing blood loss and the potential related complications.Impact statementWhat is already known on this subject? Laparoscopic myomectomy is the conservative surgical treatment of choice for symptomatic uterine fibroids. Still, it could represent a challenging procedure even for an experienced surgeon, with the risk of excessive blood loss, need of transfusions, prolonged operative time, and prolonged hospital stay. The knowledge of the predictive factors of blood loss is essential for patient preparation and surgical planning to reduce intraoperative and postoperative complications.What do the results of this study add? The results of the present study focus on the importance of presurgical evaluation to identify predictive factors of intraoperative blood loss and Hb drop such as the number of fibroids and the FIGO classification (at preoperative ultrasound), as well as intraoperative factors like operative time and the intramyometrial injection of diluted epinephrine.What are the implications of these findings for clinical practice and/or further research? A tailored approach based on the ultrasonographic characteristics of fibroids should be implemented to optimise preoperative haemoblobin levels.
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Affiliation(s)
- Giovanni Delli Carpini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Morini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Dimitrios Tsiroglou
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Valeria Verdecchia
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Michele Montanari
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Valentina Donati
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Burattini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Stefano Raffaele Giannubilo
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Ciavattini
- Obstetrics and Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
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Wang S, Wang D, Huang Q, Zhao F. Intracervical intracapsular myomectomy using loop ligation: a proposed technique. BJOG 2021; 128:2151-2156. [PMID: 34396676 DOI: 10.1111/1471-0528.16862] [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] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Performing laparoscopic myomectomy for an intracervical myoma, especially a single giant myoma, is challenging. Only skilled surgeons attempt this operation. Surgeons frequently encounter cases of massive intraoperative bleeding, difficulty suturing the cervical incision, risk of injuring the neighbouring tissues, haematoma formation and conversion to laparotomy or hysterectomy. We previously developed a the technique of loop ligation of the pseudocapsule and have been using it to treat sizeable intracervical myomas laparoscopically. Its advantages include less blood loss, lower risk of injuries to the neighbouring tissues, maintenance of the cervical canal and sparing of the pseudocapsule. This technique is safe and feasible, and facilitates fertility.
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Affiliation(s)
- S Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - D Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Q Huang
- Cancer Center, Institute of Clinical Sciences, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Respiratory Research Institute, Shanghai, China
| | - F Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Barbosa PA, Villaescusa M, Andres MP, Fernandes LFC, Abrão MS. How to minimize bleeding in laparoscopic myomectomy. Curr Opin Obstet Gynecol 2021; 33:255-261. [PMID: 34148975 DOI: 10.1097/gco.0000000000000725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Laparoscopic myomectomy is a common surgical procedure for symptomatic myomas. However, bleeding control during surgery may pose a challenge. Therefore, the aim of this study was to review recent evidence regarding interventions to control bleeding during laparoscopic myomectomy. RECENT FINDINGS The use of vasopressin resulted in less blood loss compared to placebo. Barbed sutures reduced blood loss compared to conventional sutures. Intravenous infusion of tranexamic acid (TXA) in the intraoperative period of large myomectomies showed no significant difference compared to placebo. Uterine artery occlusion (UAO) and emergency uterine artery embolization were reported to be feasible and may reduce and treat bleeding before conversion to laparotomy. SUMMARY Several methods can control bleeding during laparoscopic myomectomy. Vasopressin and barbed sutures resulted in decreased blood loss, and TXA did not have an impact on bleeding control. The use of UAO and emergency embolization techniques can contribute to the control of bleeding; however, further studies are needed to prove the efficacy of these and other agents.
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Affiliation(s)
- Priscila Almeida Barbosa
- Minimally Invasive Gynecological Surgery Program, Hospital BP - A Beneficência Portuguesa de São Paulo
| | - Marina Villaescusa
- Minimally Invasive Gynecological Surgery Program, Hospital BP - A Beneficência Portuguesa de São Paulo
| | - Marina Paula Andres
- Minimally Invasive Gynecological Surgery Program, Hospital BP - A Beneficência Portuguesa de São Paulo
- Gynecologic Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Flavio Cordeiro Fernandes
- Minimally Invasive Gynecological Surgery Program, Hospital BP - A Beneficência Portuguesa de São Paulo
- Gynecologic Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio S Abrão
- Minimally Invasive Gynecological Surgery Program, Hospital BP - A Beneficência Portuguesa de São Paulo
- Gynecologic Division Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Noh JJ, Kim J, Paik ES, Kang JH, Jeong SY, Choi CH, Lee YY, Lee JW, Kim BG, Bae DS, Kim TJ. Single-port access (SPA) laparoscopic myomectomy with uterine artery ligation via a retroperitoneal approach is feasible in women with large uterine leiomyoma. Taiwan J Obstet Gynecol 2021; 60:752-757. [PMID: 34247819 DOI: 10.1016/j.tjog.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Uterine artery ligation (UAL) at the time of myomectomy has shown to decrease blood loss during the operation. However, little is known about the efficacy and feasibility of UAL during single-port access (SPA) myomectomy. The present study was performed to investigate the clinical benefits of UAL in SPA myomectomy and to provide details of the surgical techniques. MATERIALS AND METHODS A retrospective and comparative review on the surgical outcomes of the patients who underwent SPA myomectomy with UAL and those who underwent SPA myomectomy without UAL was conducted. UAL was performed at its origin from the internal iliac artery via a retroperitoneal approach. RESULTS A total of 56 women who received SPA myomectomy were reviewed (24 patients received SPA myomectomy with UAL while 32 patients received SPA myomectomy only). The median weight of total resected leiomyomas was heavier for the patients who received UAL than those who did not receive UAL [210.0 g (range: 171.5-335.0 g) vs. 119.0 g (62.5-265.0 g), p = 0.023]. However, no differences in total operative time, estimated blood loss, perioperative hemoglobin changes, use of postoperative analgesics and postoperative complications between the two groups were seen. CONCLUSION Obtaining similar surgical outcomes between the patients who received UAL with larger leiomyomas and those who did not receive UAL with smaller leiomyomas suggests that UAL is a feasible surgical approach to reduce blood loss during SPA myomectomy. Detailed descriptions of the surgical techniques are provided in the present report.
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Affiliation(s)
- Joseph J Noh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jihye Kim
- Department of Obstetrics and Gynecology, Dankook University Hospital, Cheonan-si, Chungnam, South Korea
| | - E Sun Paik
- Department of Obstetrics and Gynecology, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Hyeok Kang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soo-Young Jeong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chel Hun Choi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeong-Won Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byoung-Gie Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Duk-Soo Bae
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Joong Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Lee SR, Kim JH, Kim S, Kim SH, Chae HD. The Number of Myomas Is the Most Important Risk Factor for Blood Loss and Total Operation Time in Robotic Myomectomy: Analysis of 242 Cases. J Clin Med 2021; 10:jcm10132930. [PMID: 34208821 PMCID: PMC8268424 DOI: 10.3390/jcm10132930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/20/2021] [Accepted: 06/26/2021] [Indexed: 12/31/2022] Open
Abstract
To identify factors affecting blood loss and operation time (OT) during robotic myomectomy (RM), we reviewed a total of 448 patients who underwent RM at Seoul Asan Hospital between 1 January 2019, and 28 February 2021, at Seoul Asan Hospital. To avoid variations in surgical proficiency, only 242 patients managed by two surgeons who each performed >80 RM procedures during the study period were included in this study. All cases of RM were performed with a reduced port technique. We obtained the following data from each patient's medical chart: age, gravidity, parity, body mass index, and history of previous abdominal surgery including cesarean section. We also collected information on the maximal diameter and type of myomas, number and weight of removed myomas, concomitant surgery, total OT from skin incision to closure, estimated blood loss (EBL), and blood transfusion. Data on preoperative use of gonadotropin-releasing hormone agonists (GnRHas) and perioperative use of hemostatic agents (tranexamic acid or vasopressin) were also collected. Data on the length of hospital stay, postoperative fever within 48 h, and any complications related to RM were also obtained. The primary endpoint in this study was the identification of factors affecting EBL and the secondary endpoint was the identification of factors affecting the total OT during multiport RM. Univariate and multivariate analyses were used to identify the factors affecting EBL and OT during multiport RM. The medians of the maximal diameter and weight of the removed myomas were 9.00 (interquartile range [IQR], 7.00 to 10.00) cm and 249.75 (IQR, 142.88 to 401.00) g, respectively. The median number of myomas was two (IQR, one to four), ranging from 1 to 34. Of the cases, 155 had low EBL and 87 had high EBL. Most myomas were of the intramural type (n = 179). The odds of EBL > 320 mL increased by 251% (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.16-5.42) for five to nine myomas and by 647% (OR, 6.47; 95% CI, 1.87-22.33) for ≥10 myomas. The odds of subserosal-type myomas decreased by 67% compared with intramural-type myomas (OR, 0.33; 95% CI, 0.14-0.80). History of abdominal surgery other than cesarean section was positively correlated with EBL. The weight of the removed myomas and a history of previous cesarean section were not correlated with the EBL. Conclusion: The number of myomas (5-9 and ≥10), maximal myoma diameter, and history of abdominal surgery other than cesarean section affect the EBL in RM.
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Affiliation(s)
- Sa Ra Lee
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea; (J.H.K.); (S.H.K.); (H.D.C.)
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
| | - Ju Hee Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea; (J.H.K.); (S.H.K.); (H.D.C.)
| | - Sehee Kim
- Asan Medical Center, Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea;
| | - Sung Hoon Kim
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea; (J.H.K.); (S.H.K.); (H.D.C.)
| | - Hee Dong Chae
- Asan Medical Center, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Seoul 05505, Korea; (J.H.K.); (S.H.K.); (H.D.C.)
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Kobylianskii A, Satkunaratnam A, Bening A, Cao X, Thomas J, Kobylianski J, Liu G, Wong H, Kung R, Kroft J. Pregnancy and Live Birth Rates After the Use of Tourniquet in Abdominal Myomectomy: A Retrospective Cohort Study. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anna Kobylianskii
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
| | - Avneet Bening
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Xingshan Cao
- Department of Evaluative Clinical Sciences and Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Judiith Thomas
- Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Canada
| | | | - Grace Liu
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Herbert Wong
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rose Kung
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jamie Kroft
- Department of Obstetrics and Gynecology and University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, Canada
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A Clinically Applicable Prediction Model for the Risk of Transfusion in Women Undergoing Myomectomy. J Minim Invasive Gynecol 2021; 28:1765-1773.e1. [PMID: 33744405 DOI: 10.1016/j.jmig.2021.03.007] [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: 02/04/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
STUDY OBJECTIVE We sought to identify the variables independently associated with intra/postoperative blood transfusion at the time of myomectomy. We further hoped to develop an accurate prediction model using preoperative variables to categorize an individual's risk of blood transfusion during myomectomy. DESIGN Case-control study. SETTING Not applicable to this study, which used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. PATIENTS Women who underwent an open/abdominal or laparoscopic (robotic or conventional) myomectomy between 2014 and 2017 at participating ACS-NSQIP sites. INTERVENTION The primary dependent variable was occurrence of intra/postoperative bleeding requiring blood transfusion. Patient demographics, clinical characteristics, preoperative comorbidities, intraoperative variables, and additional 30-day postoperative outcomes were compared at the bivariable level. For the prediction-model development, only variables that can be reasonably known before surgery were included. Variables associated with intra/postoperative bleeding were entered into 2 separate multivariable logistic regression models. Validation of our prediction model was performed internally using 250 bootstrapped iterations of 50% subsamples drawn from the overall population of myomectomy cases from the ACS-NSQIP database. MEASUREMENTS AND MAIN RESULTS We identified 6387 myomectomies performed during the defined study period. The most common race in our population was black/African American (45.7%), and most of the patients (57.5%) received an open/abdominal route of myomectomy. A total of 623 patients who underwent myomectomy (9.8%) experienced intraoperative/postoperative bleeding with a need for blood transfusion. At the bivariable level, we identified several variables independently associated with the need for blood transfusion at the time of myomectomy. In using only those variables that can be reasonably known before surgery to develop our prediction model, additional multivariable logistic regression elucidated black race, need for preoperative blood transfusion, planned abdominal/open route of surgery, and preoperative hematocrit value as independently associated with blood transfusion. CONCLUSION We identified a number of perioperative variables associated with intraoperative or postoperative bleeding requiring blood transfusion at the time of myomectomy. We subsequently created a model that accurately predicts individual bleeding risk from myomectomy, using variables that are reasonably apparent preoperatively. Making this prediction model clinically available to gynecologic surgeons will serve to improve the care of women undergoing myomectomy.
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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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Protopapas A, Kathopoulis N, Chatzipapas I, Athanasiou S, Grigoriadis T, Samartzis K, Kypriotis K, Vlachos DE, Zacharakis D, Loutradis D. Misoprostol vs vasopressin as a single hemostatic agent in laparoscopic myomectomy: Comparable, or just better than nothing? J Obstet Gynaecol Res 2020; 46:2356-2365. [PMID: 32914544 DOI: 10.1111/jog.14465] [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: 05/07/2020] [Revised: 07/14/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
AIM Laparoscopic myomectomy may be associated with considerable blood loss, especially in patients in whom no specific hemostatic measures are used. We conducted this retrospective comparative study to investigate whether misoprosol is an effective and safe alternative to vasopressin when used as single hemostatic agent in laparoscopic myomectomy. METHODS Two hundred cases undergoing laparoscopic myomectomy (-ies), were included. Of these, 50 pre-treated with vaginal misoprostol 400mcg 1 h before surgery (group 1), were compared with two historic consecutive groups: 100 patients treated with intraoperative intra-myometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2), and 50 treated without use of any hemostatic agent (group3). RESULTS Mean procedure length did not differ significantly between the three groups (127.9 vs 100.6 vs 130.8 min). Mean estimated blood loss (EBL) was 179.7 ± 200.0 mL in group 1, compared with 147.8 ± 171.8 mL in group 2 (P = 0.793) and 321.8 ± 246.0 mL in group 3, respectively (P < 0.001). EBL was lower in group 2 in most of the study's subgroups of patients stratified according to size and number of fibroids compared with group 1, with the exception of patients with ≥4 fibroids, and ≥7 cm in size. In these subgroups, misoprostol appeared more effective. Neither agent was associated with serious adverse events. CONCLUSION Vaginal misoprostol can be effective in reducing blood loss during laparoscopic myomectomy. Although rates of EBL are, in general, higher compared with those obtained with vasopressin, they are significantly reduced compared with those observed when no hemostatic agent is used. In extended procedures, vaginal misoprostol, due to its prolonged uterotonic action, may be associated with reduced blood loss compared with vasopressin.
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Affiliation(s)
- Athanasios Protopapas
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Ioannis Chatzipapas
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themistoklis Grigoriadis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Konstantinos Samartzis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Konstantinos Kypriotis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios-Eythymios Vlachos
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zacharakis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Loutradis
- 1st Department of Obstetrics & Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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MacKoul P, Danilyants N, Touchan F, van der Does LQ, Haworth LR, Kazi N. Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series. ACTA ACUST UNITED AC 2020; 17:7. [PMID: 32565764 PMCID: PMC7296894 DOI: 10.1186/s10397-020-01075-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
Background Non-hysteroscopic myomectomy is infrequently performed in a freestanding ambulatory setting, in part due to risks of intraoperative hemorrhage. There are also concerns about increased surgical risks for morbidly obese patients in this setting. The purpose of this study is to report the surgical outcomes of a series of laparoscopic-assisted myomectomy (LAM) cases at a freestanding ambulatory surgery center (ASC), including a comparative analysis of outcomes in morbidly obese patients (BMI > 40 kg/m2). Methods A retrospective comparative analysis was performed of 969 women, age 18 years or older, non-pregnant, who underwent LAM by one of two high volume, laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and February 2019. Reversible occlusion was performed laparoscopically by placing a latex-based rubber catheter as a tourniquet around the isthmus of the uterus, causing a temporary occlusion of the bilateral uterine arteries. Permanent occlusion was performed laparoscopically via retroperitoneal dissection and uterine artery ligation at the origin of the anterior branch of the internal iliac artery. Minilaparotomy was performed for specimen removal in all cases. No power morcellation was used. Postoperative complications were graded using the Clavien-Dindo Classification system. Outcomes were compared across BMI categories using Pearson Chi-Square. Results Average myoma weight and size were 422.7 g and 8.3 cm, respectively. Average estimated blood loss (EBL) was 192.1 mL; intraoperative and grade 3 postoperative complication rates were 1.4% and 1.6%, respectively. While EBL was significantly higher in obese and morbidly obese patients, this difference was not clinically meaningful, with no significant difference in blood transfusion rates. There were no statistically significant intraoperative or postoperative complication rates across BMI categories. There was a low rate of hospital transfers (0.7%) for all patients. Conclusion Laparoscopic-assisted myomectomy can be performed safely in a freestanding ambulatory surgery setting, including morbidly obese patients. This is especially important in the age of COVID-19, as elective surgeries have been postponed due to the 2020 pandemic, which may lead to a dramatic and permanent shift of outpatient surgery from the hospital to the ASC setting.
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Affiliation(s)
- Paul MacKoul
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
| | - Natalya Danilyants
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
| | - Faraj Touchan
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
| | - Louise Q van der Does
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
| | - Leah R Haworth
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
| | - Nilofar Kazi
- The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA
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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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Topical hemostatic and tissue-sealing agents in gynecologic surgery. Curr Opin Obstet Gynecol 2020; 32:285-291. [PMID: 32324712 DOI: 10.1097/gco.0000000000000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To review current topical hemostatic agent use and how it pertains to gynecologic surgery. RECENT FINDINGS Recent literature suggests some benefit of topical hemostatic agents (THA). THAs confer reduced bleeding and shorter operating room time in women undergoing hysterectomy for cancer and in abdominal myomectomy. THA use in women undergoing ovarian cystectomy is associated with a decreased reduction in ovarian reserve. Potential complications of THA use include abscess formation, small bowel obstruction, inflammation, allergic reaction, and transmission of blood-borne pathogens. Evidence for use of THA in benign minimally invasive gynecologic surgery (MIGS) procedures is lacking. SUMMARY Although evidence exists for the efficacy of THA in reducing blood loss and operating times across surgical subspecialties, specific, appropriate, and efficacious use of THAs in gynecologic surgery remains ill-defined. Knowledge of their mechanisms of action and potential complications should enable surgeons to optimize desired effects and minimize harm.
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Abstract
Objective: To review the mechanism of action, pharmacology, dosing, and complications of tranexamic acid (TXA) and consolidate current evidence for TXA in gynecologic surgery.Methods: A literature search of PubMed, Ovid (MEDLINE), Google Scholar, and Elsevier was performed, in addition to a targeted search of cited references involving TXA and gynecologic surgery. Preference was given to systematic reviews and randomized control trials (RCTs).Results: TXA reversibly binds to plasminogen, preventing clot degradation. RCTs on hysterectomy, myomectomy, cervical conisation, hysteroscopy, and surgery for cervical and ovarian cancer were identified, as were case reports on TXA use for ectopic pregnancy. During hysterectomy, TXA reduces blood loss (two RCTs, n = 432, mean difference -66.0 mL and 180 mL), blood transfusion (1 RCT, n = 100, 12% vs. 42%, p < .00001). For myomectomy, a systematic review and meta-analysis showed a statistically significant decrease in blood loss with TXA (two RCTs, mean difference -213.1 mL, 95% CI: -242.4 mL to -183.7 mL). Following cervical conisation, TXA decreased the risk of delayed hemorrhage (four RCTs, RR 0.23, 95% CI: 0.11-0.50). A single RCT for cervical and ovarian cancer surgery demonstrated a decrease mean blood loss of 120 mL-135 mL and 210 mL, respectively, and fewer blood transfusions for the latter (OR 0.44, upper 95% CI: 0.97, p = .02). Less robust data suggest a possible benefit from TXA during hysteroscopy and surgery for ectopic pregnancies. Most commonly, 1 g of intravenous TXA is given intraoperatively.Conclusion: TXA is a safe adjunct that can be considered in a variety of gynecologic surgeries to decrease blood loss and risk of blood transfusion.
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Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Ari Paul Sanders
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynecology, Peter Lougheed Centre, University of Calgary, Calgary, Canada
| | - Meir Jonathon Solnik
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Takeda A, Koike W, Tsuge S, Shibata M, Shinone S, Nakamura H. Pregnancy outcome after emergency uterine artery embolisation for management of intractable haemorrhage associated with laparoscopic-assisted myomectomy. J OBSTET GYNAECOL 2020; 40:1111-1117. [DOI: 10.1080/01443615.2019.1706156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Wataru Koike
- Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Shiori Tsuge
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Mayu Shibata
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Shinone
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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Danilyants N, Mamik MM, MacKoul P, van der Does LQ, Haworth L. Laparoscopic-assisted myomectomy: Surgery center versus outpatient hospital. J Obstet Gynaecol Res 2020; 46:490-498. [PMID: 31997510 PMCID: PMC7065249 DOI: 10.1111/jog.14197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/31/2019] [Indexed: 11/30/2022]
Abstract
Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.
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Affiliation(s)
| | - Mamta M Mamik
- Albert Einstein College of Medicine, New York, New York, USA
| | - Paul MacKoul
- The Center for Innovative GYN Care, Rockville, Maryland, USA
| | | | - Leah Haworth
- The Center for Innovative GYN Care, Rockville, Maryland, USA
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Hamed JME, Ataalla WM. Esmolol Infusion Reduces Blood Loss and Opiate Consumption during Fertility Preserving Myomectomy. Anesth Essays Res 2019; 13:423-429. [PMID: 31602056 PMCID: PMC6775852 DOI: 10.4103/aer.aer_118_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives The objective of this study is to evaluate the effect of esmolol-induced hypotensive anesthesia (EIHA) on intra-operative (IO) bleeding during open myomectomy. Patients and Methods Eighty-eight women were randomly divided into the study group received EIHA without uterine tourniquet and control group who received normotensive anesthesia with uterine tourniquet. EIHA was provided as priming dose of esmolol (0.5 mg.kg-1) before the induction of anesthesia and esmolol infusion (0.05-0.3 mg.kg-1.min-1) to maintain mean arterial pressure at 60-70 mmHg that was stopped on completion of myomectomy. Fentanyl was used as IO analgesia (loading dose: 1.0 μg.kg-1 then infusion of 0.2-0.4 μg.kg-1.h-1). All patients received 6% hydroxyethyl starch (HES; initially, 3 mL.kg-1 over 5-10 minutes and supplemental doses according to requirements) and Lactated Ringer's solution (LR; 5 mL.kg-1.h-1). Trigger for blood transfusion was hemoglobin concentration (HBC) <7 g.dL-1. Study outcomes included the extent of postoperative (PO) HBC deficit in relation to preoperative HBC, frequency of tourniquet application for the study patients, and total fentanyl consumption. Results EIHA significantly reduced blood pressure measures since laryngoscopy and tracheal intubation till the end of surgery in the study group compared to control group. Eight study patients (18.9%) required tourniquet application for control of bleeding; however, amount of IO blood loss; total field visibility score and PO HBC deficit were non significantly lower in the study group. EIHA allowed significant reduction of the IO amount of LR and additional amounts of HES infusions. Study patients group consumed significantly lower IO fentanyl doses with significantly longer duration till the 1st PO request and the number of additional fentanyl, and lower numeric rating scale scores in study group compared to controls. Conclusion Open myomectomy under EIHA is feasible and safe and allows fertility-sparing with minimal risk of blood transfusion. The applied procedure of EIHA allowed blunting of pressor reflexes secondary to LIT, surgical stresses and extubation, and allowed reduction of IO and PO opioid doses.
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Affiliation(s)
| | - Walid Mamdouh Ataalla
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Song T, Han YG, Sung JH. Comparison between the vascular control technique and conventional technique for reducing operative blood loss during robot-assisted myomectomy. Int J Med Robot 2019; 15:e2038. [PMID: 31503368 DOI: 10.1002/rcs.2038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 07/30/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND This retrospective study aimed to compare the surgical outcomes and morbidity of the vascular control technique in robotic myomectomy with the conventional technique. METHODS Thirty-two consecutive patients who underwent robotic myomectomy using laparoscopic vascular clamps in 2017 to 2019 (the practice change cohort) were retrospectively comparted with 32 case-matched consecutive patients who underwent the conventional robotic myomectomy (the historical cohort). The primary outcome was the operative blood loss and hemoglobin change. RESULTS The two cohorts had similar baseline characteristics. The mean operative blood loss and hemoglobin changes were lower in the practice change cohort than in the historical cohort (P < .001 and P = .005, respectively). Other postoperative outcomes were similar between two cohorts. CONCLUSION The vascular control technique in robotic myomectomy appears to be effective and safe in the management of selective patients with symptomatic myomas.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Gi Han
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Hee Sung
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Salazar CA, Wong MC, Miller VE, Morris SN, Isaacson KB. The Effect of Warmed Hysteroscopic Fluid-Distention Medium on Postoperative Core Body Temperature: A Randomized Trial. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina A. Salazar
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Marron C. Wong
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Valencia E. Miller
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Stephanie N. Morris
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Keith B. Isaacson
- Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, MA
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30
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[How I do… easily a laparoscopic myomectomy without blood loss]. ACTA ACUST UNITED AC 2019; 47:700-703. [PMID: 31336186 DOI: 10.1016/j.gofs.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Indexed: 01/15/2023]
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31
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Laparoscopic management of uncommon benign uterine tumors: a systematic review. Updates Surg 2019; 71:637-643. [PMID: 30941703 DOI: 10.1007/s13304-019-00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
The objective of the study was to review the reported cases of uncommon benign uterine tumors managed by laparoscopy. Medline database was searched using predefined search terms linked to atypical leiomyomas, leiomyoma variants, laparoscopy and morcellation. Quality of articles was assessed using Joanna Briggs Institute (JBI) critical appraisal tool. Due to heterogeneity in reporting characteristics of the patients, radiological findings, macroscopic findings, histological characteristics and follow-up, we performed a narrative synthesis. We included 109 cases of leiomyoma variants managed by laparoscopy. This stands for an incidence of 2.5% out of all the included laparoscopic management of leiomyomas. These cases were approached as classic leiomyoma. Only after the final histological results that their uncommon aspect was diagnosed. Intra-operatively, the management was similar to that of leiomyoma, with either myomectomy or hysterectomy performed depending on each individual case. Follow-up of these cases was variable: one case (0.9%) recurred as peritoneal sarcoma after 5 years of follow-up. It is important for the gynecologist, radiologist and pathologist to be aware about leiomyoma variants trying to diagnose them preoperatively. Strict follow-up of these cases is mandatory, because of the risk of recurrence and the very low but possible risk of future sarcomas.
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Surgical outcomes after uterine artery occlusion at the time of myomectomy: systematic review and meta-analysis. Fertil Steril 2019; 111:816-827.e4. [DOI: 10.1016/j.fertnstert.2018.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/10/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
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Zhao H, Yang B, Li H, Xu Y, Feng L. Successful Pregnancies in Women with Diffuse Uterine Leiomyomatosis after Hysteroscopic Management Using the Hysteroscopy Endo Operative System. J Minim Invasive Gynecol 2018; 26:960-967. [PMID: 30308306 DOI: 10.1016/j.jmig.2018.10.003] [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: 06/13/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To evaluate the feasibility, effectiveness, and reproductive outcome of hysteroscopic management using the Hysteroscopy Endo Operative system (HEOS) in patients with diffuse uterine leiomyomatosis (DUL). DESIGN Retrospective study (Canadian Task Force classification III). SETTING Beijing Tiantan Hospital, Capital Medical University, Beijing, China. PATIENTS Eight women of reproductive age suffering from menorrhagia and anemia or infertility diagnosed with DUL by ultrasonography and hysteroscopy. INTERVENTIONS Hysteroscopic surgery using cold graspers combined with electric loop by the HEOS was performed to excise submucous myomas (including types 0, I, and II), leaving other intramural myomas in place. The fenestration method is used in electrical hysteroscopic myomectomy. Postoperative endometrial repair and synechiae, menstrual improvement, conception, and pregnancy were recorded. MEASUREMENTS AND MAIN RESULTS Two patients underwent a single hysteroscopic myomectomy, whereas 6 patients underwent 2 to 3 myomectomies. No complications were observed. The mean follow-up period was 39.13 ± 17.01 months (range, 21-67). The endometrium recovered 2 to 3 months after the initial surgery, and 100% improvement in menstruation was observed. Two patients had mild synechia after the first hysteroscopic surgery. Seven patients conceived spontaneously (postoperative pregnancy rate, 87.5%), 6 of whom had a full-term pregnancy. One patient suffered a miscarriage in the second trimester (live birth rate, 75%). CONCLUSION Hysteroscopic surgery using cold graspers combined with electric loop by the HEOS is a feasible and effective for treatment of DUL because it preserves the uterus and yields favorable reproductive outcomes. The cold surgery and fenestration method minimizes electrical and thermal damage to the endometrium surrounding the myoma, consequently reducing surgical risks.
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Affiliation(s)
- Hui Zhao
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (all authors)
| | - Baojun Yang
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (all authors)
| | - Haixia Li
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (all authors)
| | - Yun Xu
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (all authors)
| | - Limin Feng
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (all authors)..
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Cost C. Regarding "Hemostatic Techniques for Myomectomy: An Evidence-based Approach". J Minim Invasive Gynecol 2018; 26:371. [PMID: 30278236 DOI: 10.1016/j.jmig.2018.09.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Carley Cost
- Ohio University Heritage College of Osteopathic Medicine Warrensville Heights, Ohio
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Zigman JS, Brotherton J, Truong C, Yazdany T. Surgical Planning and Counseling in Adolescence: A Case Report of a 16-Year-Old with an Aborting Pelvic Mass. Gynecol Minim Invasive Ther 2018; 7:175-177. [PMID: 30306038 PMCID: PMC6172877 DOI: 10.4103/gmit.gmit_19_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/06/2018] [Accepted: 06/29/2018] [Indexed: 11/20/2022] Open
Abstract
This case illustrates a rare finding and successful treatment of an aborting fibroid in a virginal adolescent. Careful consideration for the exam process, specific counseling, surgical planning and approach in this case are presented.
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Affiliation(s)
| | - Joy Brotherton
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, California, USA
| | - Christina Truong
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, California, USA
| | - Tajnoos Yazdany
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, California, USA
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MacKoul P, Baxi R, Danilyants N, van der Does LQ, Haworth LR, Kazi N. Laparoscopic-Assisted Myomectomy with Bilateral Uterine Artery Occlusion/Ligation. J Minim Invasive Gynecol 2018; 26:856-864. [PMID: 30170179 DOI: 10.1016/j.jmig.2018.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 07/31/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE Conventional laparoscopic myomectomy (CLM) and robotic-assisted myomectomy (RAM) are limited in the number and size of myomas that can be removed, whereas abdominal myomectomy (AM) is associated with increased complications and morbidity. Here we evaluated the surgical outcomes of these myomectomy techniques compared with those of laparoscopic-assisted myomectomy (LAM), a hybrid approach that combines laparoscopy and minilaparotomy with bilateral uterine artery occlusion or ligation to control blood loss. DESIGN Retrospective chart review (Canadian Task Force classification II-1). SETTING Suburban community hospital. PATIENTS Women age ≥18 years with nonmalignant indications. INTERVENTION A total of 1313 consecutive CLMs, RAMs, AMs, and LAMs performed between January 2011 and December 2013. MEASUREMENTS AND MAIN RESULTS Our review included 163 CLMs (12%), 156 RAMs (12%), 686 AMs (52%), and 308 LAMs (23%). Although the average number, size, and total weight of leiomyomas removed were comparable in the LAM and AM groups (9.1, 8.13 cm, and 391 g, respectively, vs 9.0, 7.5 cm, and 424 g; p < .0001), the number and weight of myomas were significantly greater in those 2 groups compared with the CLM and RAM groups (2.9 and 217 g, respectively, and 2.9 and 269 g; p < .0001). The intraoperative complication rate was highest in the RAM group, and the postoperative complication rate was highest in the AM group, both of which were approximately 3 times greater than the rates in the LAM group. There was no statistically significant difference in postoperative complication rates between the CLM and LAM groups. CONCLUSION LAM with uterine artery occlusion/ligation is a viable approach for removing large tumor loads while minimizing blood loss and precluding the need for power morcellation.
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Affiliation(s)
- Paul MacKoul
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | - Rupen Baxi
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | | | | | - Leah R Haworth
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
| | - Nilofar Kazi
- Center for Innovative GYN Care, Rockville, Maryland (all authors)
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Shady NW, Sallam HF, Fahmy H. Reducing blood loss during open myomectomy with intravenous versus topical tranexamic acid: A double-blinded randomized placebo-controlled trial. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2018. [DOI: 10.1016/j.mefs.2017.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Protopapas A, Giannoulis G, Chatzipapas I, Athanasiou S, Grigoriadis T, Kathopoulis N, Vlachos DE, Zaharakis D, Loutradis D. Vasopressin during Laparoscopic Myomectomy: Does It Really Extend Its Limits? J Minim Invasive Gynecol 2018; 26:441-449. [PMID: 29778690 DOI: 10.1016/j.jmig.2018.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/11/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE Τo investigate whether the use of vasopressin played an important role in the safe expansion of the indications of laparoscopic myomectomy in our practice. DESIGN A retrospective comparison of prospectively collected data (Canadian Task Force classification II2). SETTING A gynecologic endoscopy unit in a tertiary university hospital. PATIENTS One hundred fifty patients undergoing laparoscopic myomectomy; 50 were treated without the use of any vasoconstrictive agent (group 1), and 100 were treated with intraoperative intramyometrial injection of dilute vasopressin (20 IU/100 mL normal saline) (group 2). INTERVENTIONS Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS We compared the 2 groups in terms of size, number, and type of myomas; estimated blood loss (EBL); procedure length; transfusion rates; laparoconversion rates; and rates of complications. Two cases in group 1 (4%) were laparoconverted versus none (0%) in group 2. Overall, the mean EBL was 321.8 ± 246.0 mL in group 1 compared with 147.8 ± 171.8 mL in group 2, respectively (p <.001). Additionally, EBL was significantly lower in the vasopressin group in all of the study's subgroups of patients stratified according to the size and number of myomas. Procedure length did not differ significantly between the 2 groups (130.8 ± 49.5 vs 115.6 ± 49.4 minutes, p = .078). The risk factors for prolongation of the procedure included size and number of myomas independently of vasopressin. The rates of hypercapnea and subcutaneous emphysema were higher in group 1. The risk factors for hypercapnea and subcutaneous emphysema included the size and intramural position of the largest myoma. Vasopressin was not associated with serious cardiovascular adverse events. CONCLUSIONS Vasopressin is effective in reducing blood loss during laparoscopic myomectomy. Although experienced surgeons may achieve comparable operation times without vasopressin, even in the most challenging cases, blood loss may still be considerable. The occurrence of hypercapnea is higher in untreated cases and may contribute to laparoconversion.
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Affiliation(s)
- Athanasios Protopapas
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
| | - George Giannoulis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Ioannis Chatzipapas
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Stavros Athanasiou
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Themistoklis Grigoriadis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios-Efthymios Vlachos
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Zaharakis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
| | - Dimitrios Loutradis
- Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece
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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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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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Xue A, Lin J, Que C, Yu Y, Tu C, Chen H, Liu B, Zhao X, Wang T, Ma K, Li L. Aberrant endoplasmic reticulum stress mediates coronary artery spasm through regulating MLCK/MLC2 pathway. Exp Cell Res 2018; 363:321-331. [DOI: 10.1016/j.yexcr.2018.01.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/02/2018] [Accepted: 01/23/2018] [Indexed: 11/25/2022]
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Clark NV, Wang KC, Opoku-Anane J, Hill-Lydecker CI, Vitonis AF, Einarsson JI, Cohen SL. The menstrual cycle and blood loss during laparoscopic myomectomy. Acta Obstet Gynecol Scand 2017; 96:1446-1452. [PMID: 28981986 DOI: 10.1111/aogs.13240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Nisse V Clark
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen C Wang
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jessica Opoku-Anane
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Catherine I Hill-Lydecker
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Allison F Vitonis
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Jon I Einarsson
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
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Resectoscopic Surgery for Polyps and Myomas: A Review of the Literature. J Minim Invasive Gynecol 2017; 24:1104-1110. [PMID: 28843536 DOI: 10.1016/j.jmig.2017.08.645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/21/2022]
Abstract
Resectoscopic surgery is routinely performed to remove endometrial polyps and uterine myomas. A search of Medline, PubMed, and the Cochrane Library was conducted through November 2016 for studies written in English, regardless of sample size or study type. The studies were then filtered by selecting those evaluating resectoscopic surgery. An analysis of peer-reviewed, published literature was performed to examine the clinical application of this treatment modality on patients requiring polypectomy and myomectomy. Different surgical techniques were also compared: hysteroscopy with scissors, forceps, or a cold loop; resectoscopy with radiofrequency energy; and mechanical resection. The literature finds that operative time during resectoscopic surgery is significantly longer than with mechanical resection. Resectoscopic myomectomy, however, may be necessary for removal of larger or more deeply embedded myomas. Ultimately, both techniques result in symptom resolution and a low recurrence rate.
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Comment on "Laparoscopic Myomectomy of a Symptomatic Uterine Leiomyoma in a 15-Year-Old Adolescent". J Pediatr Adolesc Gynecol 2017; 30:442-443. [PMID: 27965124 DOI: 10.1016/j.jpag.2016.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/29/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022]
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Role of robotic surgery in treating fibroids and benign uterine mass. Best Pract Res Clin Obstet Gynaecol 2017; 45:48-59. [PMID: 28551090 DOI: 10.1016/j.bpobgyn.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/31/2022]
Abstract
Fibroid uterus can be managed medically, surgically, or through non-extirpative procedures, depending on the clinical situation. Myomectomy may be beneficial, especially to those desiring to preserve the uterus and/or fertility, with outcomes comparable to those of hysterectomy, with a laparoscopic approach being favored when feasible. For definitive therapy, hysterectomy can be pursued where the surgical approach should be individualized. Comparison of robotic-assisted laparoscopic approach shows that the robotic approach may be favored for cases with higher complexity and multiple fibroids in myomectomy; however, no clear advantage is seen with hysterectomy at this time, necessitating further research in the area of robotics for hysterectomy in benign uterine mass treatment to justify the cost.
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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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Robotic-Assisted Laparoscopic Myomectomy versus Traditional Laparoscopic Myomectomy: Are They the Same? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0182-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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