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Siebert T, Moersdorf G, Colberg T. Laparoscopic application of sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Systematic Review Protocols-compliant systematic review and meta-analysis. Surgery 2024; 175:1358-1367. [PMID: 38429164 DOI: 10.1016/j.surg.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND We aimed to evaluate the incidence of postoperative adhesion formation and adhesion-related consequences (eg, bowel obstruction) after placement of a sodium hyaluronate-carboxymethylcellulose adhesion barrier after laparoscopic abdominopelvic surgery. METHODS In this systematic review and meta-analysis, we searched the Medical Literature Analysis and Retrieval System Online and Embase via Ovid, Cochrane Central Register of Controlled Trials, ScienceDirect, BIOSIS Previews, Cumulative Index to Nursing and Allied Health Literature, and Clinical Trial Registries. A manual search (eg, Google Scholar and professional association websites) was also conducted to supplement the electronic database results. Two reviewers independently identified relevant studies based on inclusion and exclusion criteria and extracted data. RESULTS A total of 28 studies were included in the systematic qualitative review. Three of the 28 studies included had comparable outcome measures, interventions, and control groups, allowing the pooling of study data. A total of 938 patients (490 patients in the sodium hyaluronate-carboxymethylcellulose barrier group and 448 in the no adhesion barrier group) from these 3 studies were included in the meta-analyses, which found the incidence of bowel obstruction was significantly lower (65% risk reduction) in the sodium hyaluronate-carboxymethylcellulose barrier group compared with the control group (relative risk = 0.35; 95% confidence interval, 0.19-0.63; P = .005) with extremely low heterogeneity between studies (I2 = 0; P = .41). The placement of sodium hyaluronate-carboxymethylcellulose barrier laparoscopically did not create new safety signals nor did it increase the incidence of adverse events. CONCLUSION Our meta-analysis found that laparoscopic application of a sodium hyaluronate-carboxymethylcellulose barrier in abdominopelvic surgery reduces the risk of bowel obstruction where applied during the early postoperative phase.
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Affiliation(s)
- Terri Siebert
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL.
| | | | - Torben Colberg
- Medical Affairs, Baxter Healthcare Corporation, Deerfield, IL
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Thanasa A, Thanasa E, Kamaretsos E, Grapsidi V, Xydias E, Ziogas A, Gerokostas EE, Antoniou IR, Paraoulakis I, Thanasas I. Surgical treatment of a very rare case of a huge intraligamental leiomyoma of the uterus: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2024; 4:2. [PMID: 38107473 PMCID: PMC10719964 DOI: 10.3892/mi.2023.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Intraligamental leiomyomas of the uterus are rare. Extremely rare are the huge intraligamental fibroids (>20 cm), whose pre-operative diagnosis and surgical management poses a challenge to everyday clinical practice. The present study describes the case of patient who was subjected to surgical treatment for a huge intraligamental leiomyoma of the uterus, which weighed 3,370 g. A 48-year-old patient, without menstrual disorders and with a medical history of atypical symptoms from the digestive tract, was referred for a gynecological examination. Upon a physical examination, the abdomen was found to be bloated and distended, with no signs of peritoneal irritation. An intra-abdominal mass was suspected, the upper margin of which was palpable at about the level of the xiphoid process. The findings of computed tomography and magnetic resonance imaging confirmed the presence of a huge intra-abdominal mass, which probably originated from the internal genital organs. Following consultation with the patient, surgical treatment with laparotomy was decided. Intraoperatively, a large pedunculated subserosal leiomyoma was found, arising from the right lateral wall of the uterus with retroperitoneal extension within the leaves of broad ligament. Following the resection of the intraligamental leiomyoma, which had significant surgical challenges, a total hysterectomy with bilateral adnexectomy was performed. The post-operative course was smooth. In addition, in the present study, a brief review of intraligamental leiomyomas of the uterus is presented, emphasizing the significant diagnostic and surgical challenges and potential intraoperative complications that may arise in the management of patients with this condition.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Emmanouil Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece
| | - Apostolos Ziogas
- Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece
| | | | | | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
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Wang S, Wang D, Zhao F. A combination of two novel ligation techniques for complicated laparoscopic intraligamental myomectomy. Fertil Steril 2022; 118:207-209. [PMID: 35537898 DOI: 10.1016/j.fertnstert.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform laparoscopic myomectomy by combining two novel ligation techniques for a large lateral intraligamental myoma. DESIGN A step-by-step explanation of the surgical procedure using a video with narration. SETTING University hospital. PATIENT(S) A 39-year-old woman (gravida 1, para 0) presented with an asymptomatic pelvic mass. Sonographic imaging revealed a 10-cm subserous myoma from the right lateral uterine isthmus wall. Laparoscopic exploration revealed a large myoma growing from the right lateral cervical isthmus wall toward the broad ligament. It was protruding into the pararectal space with duplicated ureters. INTERVENTION(S) For such a large lateral intraligamental myoma, any conventional approach has the potential to cause massive bleeding and accidental injuries. We devised and implemented a preventative strategy for intraoperative bleeding by combining two novel ligation techniques used in laparoscopic myomectomy. We made an incision at the posterior leaf of the broad ligament and exposed the myometrium enveloping the fibroid and the base of the fibroid. Then we performed an incision 2 cm away from the right lower edge of the fibroid base, opening the myometrium and pseudocapsule. We applied two novel ligation techniques that ligate the pedicle on the left of the fibroid and the pseudocapsule on the right of the fibroid. Enucleation and loop tightening were implemented simultaneously. The entire pseudocapsule and most of the myometrium enveloping the fibroid were ligated in the loop knot. Only a small portion of the myometrium on the right side was outside the loop knot, which required electrocoagulation. Loop ligation was performed twice more for reinforcement in the same location. The peritoneum was then closed. MAIN OUTCOME MEASURE(S) Laparoscopic myomectomy was completed successfully for a large lateral intraligamental myoma using our novel technique. RESULT(S) The surgery lasted 110 min, and the volume of intraoperative blood loss was 150 mL. The patient had a normal postoperative course. CONCLUSION(S) Combining two novel ligation techniques in laparoscopic myomectomy is a safe and efficient surgical choice. This technique has obvious advantages in large, broad ligament myomas, reducing bleeding and avoiding unintentional injuries, even in duplicated ureters. Furthermore, this technique is not limited by the device and does not increase the cost of surgery.
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Affiliation(s)
- Shengke Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
| | - Dongdong Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
| | - Fujie Zhao
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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Laparoendoscopic two-site myomectomy (LETS-M) using conventional laparoscopic instruments and the glove-port technique. J Formos Med Assoc 2022; 121:2248-2256. [DOI: 10.1016/j.jfma.2022.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/24/2022] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
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Yajima R, Kido A, Kuwahara R, Moribata Y, Chigusa Y, Himoto Y, Kurata Y, Matsumoto Y, Otani S, Nishio N, Minamiguchi S, Mandai M, Nakamoto Y. Diagnostic performance of preoperative MR imaging findings for differentiation of uterine leiomyoma with intraligamentous growth from subserosal leiomyoma. Abdom Radiol (NY) 2021; 46:4036-4045. [PMID: 33796904 DOI: 10.1007/s00261-021-03042-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of MRI findings for differentiating uterine leiomyoma with intraligamentous growth, or broad ligament fibroid, from subserosal leiomyoma. METHODS This study included 37 patients with surgically confirmed uterine smooth muscle tumors (36 leiomyomas and one smooth muscle tumor of uncertain malignant potential) with intraligamentous growth (IL) and size-matched control of 37 patients with subserosal leiomyoma (SS). Two radiologists independently evaluated eight preoperative MRI findings: tumor shape, degeneration, attachment to uterus, ovary elevation, ureter displacement, bladder deformation, rectal displacement, and separation of round ligament (RL) and uterine artery (UA). The diagnostic values of these findings and interobserver agreement were assessed. Receiver-operating characteristic (ROC) analysis of the number of positive MRI findings for diagnosing IL was performed. Clinical outcomes including surgical method, operation time, intraoperative blood loss, perioperative complications, and postoperative hospital stay of the two groups were compared. RESULTS Significant differences in tumor shape, attachment to uterus, ovary elevation, ureter displacement, and separation of RL and UA were found between IL and SS. Four of these findings, excluding ureter displacement, showed moderate to substantial interobserver agreement. When two or more of these four findings were positive, sensitivity, specificity, and area under the ROC curve were 91%, 77%, 0.90 in reader 1 and 82%, 89%, 0.91 in reader 2. The operation time was significantly longer for IL than for SS. CONCLUSION Tumor shape, attachment to uterus, ovary elevation, and separation of RL and UA are useful MRI findings for differentiating intraligamentous leiomyoma from subserosal leiomyoma.
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Huang KJ, Li YX, Sheu BC, Chang WC. Two-port access for laparoscopic surgery for endometrial cancer using conventional laparoscopic instruments. Sci Rep 2021; 11:615. [PMID: 33436739 PMCID: PMC7804851 DOI: 10.1038/s41598-020-79886-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/14/2020] [Indexed: 01/23/2023] Open
Abstract
Minimally invasive surgery is the first-line management for endometrial cancer. The role of 2-port access laparoscopy (TPA) has been underestimated. Compared to conventional laparoscopic surgery (CL), TPA is associated with smaller total incision size and less postoperative pain. Compared to single-incision laparoscopic surgery, no specific instruments and surgical techniques are needed. This study primarily evaluated the surgical and pathologic outcomes of TPA with conventional instruments, and additionally evaluated the surgeon's learning curve. Consecutive patients who underwent TPA and CL for endometrial cancer between 2015 and 2019 were included. Baseline characteristics were recorded. In total, 148 patients (TPA, 89; CL, 59) were identified. The baseline characteristics were similar, except for a greater proportion of patients in the CL group receiving para-aortic lymph node dissection (5.62% vs. 35.59%, P < 0.01). The mean operation time was significantly less in the TPA group (152.09 vs. 187.15 min; P < 0.01). Both the groups had comparable 5-year progression-free survival (TPA, 86.68%) and 5-year overall survival rates (TPA, 93.24%). Analysis of the learning curve showed that the operation time decreased after 3-4 procedures. TPA using conventional laparoscopic instruments for endometrial cancer is feasible and is easily accessible to patients and surgeons.
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Affiliation(s)
- Kuan-Ju Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Xuan Li
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, Taiwan.
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Ambrosio M, Raimondo D, Savelli L, Salucci P, Arena A, Borghese G, Mattioli G, Giaquinto I, Scifo MC, Meriggiola MC, Casadio P, Seracchioli R. Transvaginal Ultrasound and Doppler Features of Intraligamental Myomas. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1253-1259. [PMID: 31944342 DOI: 10.1002/jum.15213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe the ultrasound (US) features of intraligamental myomas (IMs) using Morphological Uterus Sonographic Assessment group standardized terminology. METHODS This was a retrospective monocentric study. A total of 125 consecutive women with a preoperative US diagnosis of a myoma located close to the uterine isthmus (International Federation of Gynecology and Obstetrics stages 5, 6, and 7) from 2016 to 2019 who underwent laparoscopic or laparotomic myomectomy or hysterectomy were included for study analyses. The US data were retrieved from US reports and stored digital images by 2 authors. Ultrasound features of myomas were described according to Morphological Uterus Sonographic Assessment terminology. Clinical data for the study population were retrieved from the patients' records. RESULTS Nineteen women with a surgical confirmation of an IM were included in the study group; the remaining population constituted the control group (n = 106). Non-uniform echogenicity was detected in 17 of 19 (89%) of IMs compared to 26 of 106 (25%) fibroids in the control group (P < .001). The presence of shadowing was detected in 12 of 19 (63%) IMs compared to 94 of 106 (89%) cases in the control group (P = .004). Intraligamental myomas were more vascularized tumors compared to myomas in the control group (P = .004). Transvaginal US showed high specificity for the diagnosis of an IM (0.93; 95% confidence interval, 0.87-0.96). CONCLUSIONS On US imaging, IMs appear as vascularized solid tumors with nonuniform echogenicity; cones of shadows were less frequent in IMs than the control group, and this finding can help in the differential diagnosis. Knowledge of their specific US features could help sonographers make an accurate diagnosis, allowing them to plan correct surgery and avoid severe complications.
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Affiliation(s)
- Marco Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Luca Savelli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Salucci
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Arena
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Borghese
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Mattioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Giaquinto
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Cristina Meriggiola
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Casadio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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Frishman GN. So What Do Cesarean Section Scar Diverticula and Intraligamental Fibroids Have in Common? J Minim Invasive Gynecol 2016; 23:1019-1020. [DOI: 10.1016/j.jmig.2016.08.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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