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Cunningham JG, Summerell L, Mather A, Balica A. Asymptomatic Myometrial Dehiscence in Pregnancy. J Minim Invasive Gynecol 2024:S1553-4650(24)00220-6. [PMID: 38761919 DOI: 10.1016/j.jmig.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Jessica G Cunningham
- Prisma Health/University of South Carolina School of Medicine Columbia OB/GYN Residency Program, Columbia, South Carolina (Drs. Cunningham and Summerell)
| | - Lauren Summerell
- Prisma Health/University of South Carolina School of Medicine Columbia OB/GYN Residency Program, Columbia, South Carolina (Drs. Cunningham and Summerell)
| | - Andrew Mather
- Prisma Health Maternal Fetal Medicine, Columbia, South Carolina (Dr. Mather); Prisma Health Obstetrics and Gynecology, Columbia, South Carolina (Drs. Mather and Balica)
| | - Adrian Balica
- Prisma Health Obstetrics and Gynecology, Columbia, South Carolina (Drs. Mather and Balica); University of South Carolina School of Medicine, Columbia, South Carolina (Dr. Balica).
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Cianci S, Gulino FA, Palmara V, La Verde M, Ronsini C, Romeo P, Occhipinti S, Incognito GG, Capozzi VA, Restaino S, Vizzielli G, Palumbo M. Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:64. [PMID: 38256325 PMCID: PMC10820219 DOI: 10.3390/medicina60010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient's age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as "myomectomy laparoscopic and open", "myomectomy open and minimally invasive", "myomectomy open and laparoscopic", and "myomectomy open vs. laparoscopic." The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.
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Affiliation(s)
- Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy; (F.A.G.); (V.P.); (P.R.)
| | - Ferdinando Antonio Gulino
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy; (F.A.G.); (V.P.); (P.R.)
| | - Vittorio Palmara
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy; (F.A.G.); (V.P.); (P.R.)
| | - Marco La Verde
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.L.V.); (C.R.)
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (M.L.V.); (C.R.)
| | - Paola Romeo
- Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98122 Messina, Italy; (F.A.G.); (V.P.); (P.R.)
| | - Sara Occhipinti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy; (S.O.); (G.G.I.); (M.P.)
| | - Giosuè Giordano Incognito
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy; (S.O.); (G.G.I.); (M.P.)
| | - Vito Andrea Capozzi
- Department of Obstetrics and Gynecology, University of Parma, 43125 Parma, Italy;
| | - Stefano Restaino
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.V.)
| | - Giuseppe Vizzielli
- Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (S.R.); (G.V.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy; (S.O.); (G.G.I.); (M.P.)
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Wang L, Deng JY, Li KP, Zhu PY. A systematic review and meta-analysis comparing robotic single-site versus multi-port myomectomy. J Robot Surg 2023:10.1007/s11701-023-01597-9. [PMID: 37093509 DOI: 10.1007/s11701-023-01597-9] [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: 03/14/2023] [Accepted: 04/09/2023] [Indexed: 04/25/2023]
Abstract
The objective of this study was to compare the surgical outcomes of robotic multi-site myomectomy (RMSM) with those of robotic single-site myomectomy (RSSM). We conducted a systematic search of the PubMed, CINAHL, Scopus, and Google Scholar databases for articles comparing RMSM and RSSM until March 2023. Data analysis was performed using Review Manager V5.3 (Cochrane), and the main outcomes examined were perioperative outcomes and complications. A total of five studies, covering 823 patients, were included in the analysis. The statistical analysis revealed no significant differences between RMSM and RSSM with regard to docking time (p = 0.9), console time (p = 0.37), estimated blood loss (p = 0.38), postoperative hemoglobin (Hb) loss (p = 0.61), transfusion rate (p = 0.25), length of stay (p = 0.08), conversion (p = 0.36), postoperative fever (p = 0.46), intraoperative complication (p = 0.23), or postoperative complication (p = 0.12). However, compared to RMSM, RSSM was found to have a shorter morcellation time (weighted mean difference [WMD] - 4.52 min; 95% confidence interval [CI] - 6.89 to 2.15; p = 0.0002), less total operative time (WMD - 9.83 min; 95% CI - 18.27 to - 1.38; p = 0.02), lower Hb change (WMD - 0.28 g/dL; 95% CI - 0.49 to - 0.07; p = 0.008), and fewer overall complications (odds ratio [OR] 0.55; 95% CI 0.32-0.92; p = 0.02). Our findings suggest that RSSM is a safe and effective alternative to RMSM for the most studied outcomes. Further randomized studies are necessary to validate these results.
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jing-Ya Deng
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kun-Peng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Li F, Chen J, Yin L, Zeng D, Wang L, Tao H, Wu X, Wei F, Xu F, Shi Q, Lin Z, Wang Z. HIFU as an alternative modality for patients with uterine fibroids who require fertility-sparing treatment. Int J Hyperthermia 2023; 40:2155077. [PMID: 36603842 DOI: 10.1080/02656736.2022.2155077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To compare pregnancy outcomes after high-intensity focused ultrasound ablation (HIFU), myomectomy and uterine artery embolization (UAE) for fertility-sparing patients with uterine fibroids and to investigate the possible mechanism of improving pregnancy by HIFU. MATERIALS AND METHODS A meta-analysis of 54 studies containing 12,367 patients was conducted to compare the pregnancy outcomes of three fertility-sparing therapies. And a retrospective self-control study of 26 patients with uterine fibroids from May 2019 to December 2020 was performed to assess the blood flow impedance of bilateral uterine arteries before and after HIFU. RESULTS In the analysis by treatment option, the pregnancy rate after myomectomy was 0.43 (95% CI 0.36-0.49), which was higher than 0.18 (95% CI 0.10-0.26) after HIFU, the latter was significantly higher than that after UAE (ratio 0.08, 95% CI 0.06-0.10). The miscarriage rate after HIFU was 0.08 (95% CI 0.04-0.12), which was similar to 0.15 (95% CI 0.09-0.21) after myomectomy and also similar to 0.16 after UAE (95% CI 0.01-0.30). In the subgroup analysis, women who received ultrasound guided HIFU (USgHIFU) were more likely to have ideal pregnancy outcomes than that after magnetic resonance imaging-guided HIFU. The pulsatility index and resistance index on the right side were significantly higher 3 months after HIFU than before (1.637 ± 0.435 vs. 1.845 ± 0.469; p = 0.033; 0.729 ± 0.141 vs. 0.784 ± 0.081, p = 0.039). CONCLUSIONS HIFU, especially USgHIFU, may be an alternative fertility-sparing modality for patients with uterine fibroids over 40 years old. HIFU may contribute to improving pregnancy rates by elevating uterine blood flow impedance.
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Affiliation(s)
- Fang Li
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Jing Chen
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Yin
- Xiamen Maluan Bay Hospital, Xiamen, China
| | - Dingyuan Zeng
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Li Wang
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Hua Tao
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Xiajuan Wu
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Feng Wei
- Liuzhou Maternity and Child Healthcare Hospital, Affiliated Women and Children's Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Fan Xu
- Nanchong Central Hospital, North Sichuan Medical University, Nanchong, China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound Engineering in Medicine, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Zhong Lin
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, China
| | - Zhibiao Wang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
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Kim JM, Lee YH, Chong GO, Lee SR, Hong DG. Comparison of Multi- and Single-Site Robotic Myomectomy Using the Da Vinci ® SP Surgical System: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11236905. [PMID: 36498480 PMCID: PMC9741369 DOI: 10.3390/jcm11236905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: This study aimed to compare the surgical outcomes between robotic multi-site myomectomy (RMSM) and robotic single-site myomectomy (RSSM), using the da Vinci® SP surgical system and perform propensity score matching analysis to ensure inter-group comparability. Methods: This retrospective study included 105 patients who underwent either three-incision RMSM or RSSM using the da Vinci® SP surgical system. We retrospectively reviewed and compared surgical outcomes using 1:1 propensity score matching. Results: After 1:1 propensity score matching, there were no differences in the total operation time and estimated blood loss between the groups. The docking time (p < 0.0001) and duration of hospital stay (p = 0.0001) were significantly shorter in the RSSM group than in the RMSM group. Conclusions: The surgical outcomes of RSSM were comparable to those of RMSM. Moreover, compared to RMSM, RSSM using the da Vinci® SP surgical system has shorter docking and morcellation times, and duration of hospital stay.
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Affiliation(s)
- Jong Mi Kim
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Yoon Hee Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
- Correspondence: (Y.H.L.); (G.O.C.)
| | - Gun Oh Chong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Clinical Omics Research Center, School of Medicine, Kyungpook National University, Daegu 41566, Republic of Korea
- Correspondence: (Y.H.L.); (G.O.C.)
| | - Sae Rom Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
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Successful laparoscopic management of acute abdominal pain due to spontaneous rupture of subserosal vessels overlying a uterine fibroid: a case report and surgical video. BMC Womens Health 2022; 22:388. [PMID: 36138425 PMCID: PMC9502635 DOI: 10.1186/s12905-022-01970-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Acute abdomen comprises several emergencies. Hemoperitoneum associated with uterine fibroids, which can present as acute abdominal pain, is rare and difficult to diagnose. Especially, spontaneous hemorrhage from the rupture of the superficial vessels overlying a uterine fibroid is extremely rare, and its diagnosis and management have not been established. Case presentation We report a case of a 55-year-old woman who presented at our hospital with acute abdomen. After performing a computed tomography scan, we conducted a laparoscopic examination and diagnosed hemoperitoneum of ambiguous origin. We treated the patient surgically, performing a laparoscopic myomectomy to remove the origin of the hemorrhage. The patient recovered well. Conclusions We report a case of hemoperitoneum of ambiguous origin that was diagnosed laparoscopically and treated by laparoscopic myomectomy to remove the origin of the hemorrhage. Surgeons should rapidly diagnose and manage acute abdominal pain in women with a history of uterine fibroids to prevent severe morbidity or even mortality. Therefore, laparoscopic surgery is recommended in patients with stable hemodynamics. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01970-0.
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Use of a microsurgical vascular clip system for temporary bilateral occlusion of the four main uterine vessels for laparoscopic enucleation of very large intramural uterine fibroids. Arch Gynecol Obstet 2022; 306:1597-1605. [PMID: 35882651 PMCID: PMC9519638 DOI: 10.1007/s00404-022-06675-1] [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: 01/06/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Objectives The goal of this study was to examine the safety, feasibility, and effectiveness of the use of a microsurgical temporary vascular clip system to facilitate the laparoscopic enucleation of very large intramural uterine fibroids. Methods In this retrospective study, the surgical outcomes of 26 patients who underwent laparoscopic myomectomy with temporary uterine vessel clipping for very large (the largest measured diameter ≥ 9 cm) symptomatic intramural uterine fibroids in two tertiary referral hospitals between September 2017 and March 2020 were examined. Titan-made vascular clips (YASARGIL® Aneurysm Clip System) were used to temporarily occlude the bilateral uterine arteries and utero-ovarian vessels. Main outcomes included operating time, blood loss, number of leiomyomas and weight, conversion rate, intra- and postoperative complication rates, and length of hospital stay. Results Twenty six patients were included. Dominant intramural uterine fibroid diameters were 9–22 cm. The general characteristics of the patients were similar. The mean surgery duration and intraoperative blood loss were 175.3 ± 32.7 (range 120–250) min and 241.1 ± 103 (range 100–450) ml, respectively. The median postoperative drop in hemoglobin was 0.89 ± 0.75 g/dL. No patient required blood transfusion. No procedure was converted to laparotomy. No major intra- or postoperative complication occurred. Conclusions Laparoscopic myomectomy for very large intramural uterine fibroids can be performed safely and effectively, with less intraoperative blood loss, using vascular clips for temporary clamping of the bilateral uterine vessels.
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Takeda A, Shibata M, Koike W. Early identification of uterine scar defect by preconception magnetic resonance imaging to achieve successful pregnancy outcome after laparoscopic‐assisted myomectomy: Two case reports. Clin Case Rep 2022; 10:e05441. [PMID: 35169475 PMCID: PMC8832169 DOI: 10.1002/ccr3.5441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology Gifu Prefectural Tajimi Hospital Tajimi Japan
| | - Mayu Shibata
- Department of Obstetrics and Gynecology Gifu Prefectural Tajimi Hospital Tajimi Japan
| | - Wataru Koike
- Department of Diagnostic Radiology Gifu Prefectural Tajimi Hospital Tajimi Japan
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Meng W, Lin WL, Yeung WF, Zhang Y, Ng EHY, Lee YPE, Zhang ZJ, Rong J, Lao L. Randomized double-blind trial comparing low dose and conventional dose of a modified traditional herbal formula Guizhi Fuling Wan in women with symptomatic uterine fibroids. JOURNAL OF ETHNOPHARMACOLOGY 2022; 283:114676. [PMID: 34562564 DOI: 10.1016/j.jep.2021.114676] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 06/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The herbal formula Guizhi Fuling Wan is one common remedy for treating uterine fibroids (UFs) and the relevant symptoms in Traditional Chinese Medicine (TCM). Previous systematic reviews showed that Guizhi Fuling Formula appeared to have additional benefit based on mifepristone treatment in reducing volume of fibroids. AIM OF STUDY To study the efficacy and safety of the conventional dose of a modified herbal formula Guizhi Fuling Wan in patients with symptomatic uterine fibroids in comparison with a sub-effective dose control. MATERIALS AND METHODS This randomized double-blind, dosage-controlled trial was carried out in an outpatient clinic of traditional Chinese medicine in Hong Kong. Women with symptomatic uterine fibroids diagnosed according to the WHO International Classification of Diseases (ICD-10) were recruited and randomly assigned to one of two groups that received modified Guizhi Fuling Wan at either a low dose or the conventional dose on a daily basis for 16 weeks. This study was quality controlled by a data safety monitoring board. The primary outcome was the symptom severity as measured with the Uterine Fibroid Symptom-Quality of Life questionnaire. The secondary outcomes included quality of life, menstrual bleeding (measured on a pictorial blood loss assessment chart), pain severity (measured on the 6-point behavioral rating scale), change in Chinese medicine syndrome score, fibroid volume (measured by magnetic resonance imaging), hemoglobin level, and hormone levels. RESULTS Seventy-eight women were recruited for this study. Between-groups comparison showed no significant difference at the endpoint for all outcomes except for the Chinese medicine syndrome score; however, at the endpoint, within-group comparison showed significant improvement in both groups relative to baseline in symptom severity, functional influence of pelvic pain, Chinese medicine syndrome score, and fibroid volume and uterus condition on magnetic resonance imaging (p < 0.05).The low-dose group yielded greater endpoint improvement in the Chinese medicine syndrome score than the conventional-dose group (p=0.024). No serious adverse events related to the intervention were noted. CONCLUSION Both low-dose and conventional-dose preparations significantly ameliorated uterine fibroid-related symptoms and fibroid volume, although no significant difference was found between the low-dose and conventional-dose groups. The herbal formula GuizhiFuling Wan is safe in women with uterine fibroids.
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Affiliation(s)
- Wei Meng
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Hong Kong Branch of Zhu's School of Gynecology of Chinese Medicine from Shanghai Workstation of Zhu Nansun, National Master of Chinese Medicine, School of Chinese Medicine, The University of Hong Kong, Hong Kong; Hong Kong Branch of Yu Jin, Masters of Gynaecology of Integrative Medicine, Workstations for Training and Research, Hong Kong.
| | - Wai Ling Lin
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong.
| | - Yangbo Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Ernest Hung Yu Ng
- Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
| | - Yuen Phin Elaine Lee
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Department of Chinese Medicine, Gleneagles Hospital, Hong Kong.
| | - Jianhui Rong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Lixing Lao
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Department of Chinese Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China; Virginia University of Integrative Medicine, Fairfax, USA.
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Purandare N, Kramer KJ, Minchella P, Ottum S, Walker C, Rausch J, Chao CR, Grossman LI, Aras S, Recanati MA. Intraperitoneal Triamcinolone Reduces Postoperative Adhesions, Possibly through Alteration of Mitochondrial Function. J Clin Med 2022; 11:jcm11020301. [PMID: 35053996 PMCID: PMC8779954 DOI: 10.3390/jcm11020301] [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: 12/06/2021] [Revised: 12/29/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
Adhesions frequently occur postoperatively, causing morbidity. In this noninterventional observational cohort study, we enrolled patients who presented for repeat abdominal surgery, after a history of previous abdominal myomectomy, from March 1998 to June 20210 at St. Vincent’s Catholic Medical Centers. The primary outcome of this pilot study was to compare adhesion rates, extent, and severity in patients who were treated with intraperitoneal triamcinolone acetonide during the initial abdominal myomectomy (n = 31) with those who did not receive any antiadhesion interventions (n = 21), as documented on retrospective chart review. Adhesions were blindly scored using a standard scoring system. About 32% of patients were found to have adhesions in the triamcinolone group compared to 71% in the untreated group (p < 0.01). Compared to controls, adhesions were significantly less in number (0.71 vs. 2.09, p < 0.005), severity (0.54 vs. 1.38, p < 0.004), and extent (0.45 vs. 1.28, p < 0.003). To understand the molecular mechanisms, human fibroblasts were incubated in hypoxic conditions and treated with triamcinolone or vehicle. In vitro studies showed that triamcinolone directly prevents the surge of reactive oxygen species triggered by 2% hypoxia and prevents the increase in TGF-β1 that leads to the irreversible conversion of fibroblasts to an adhesion phenotype. Triamcinolone prevents the increase in reactive oxygen species through alterations in mitochondrial function that are HIF-1α-independent. Controlling mitochondrial function may thus allow for adhesion-free surgery and reduced postoperative complications.
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Affiliation(s)
- Neeraja Purandare
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI 48201, USA; (N.P.); (L.I.G.); (S.A.)
| | - Katherine J. Kramer
- Department of Obstetrics and Gynecology, St. Vincent’s Medical Centers Manhattan, New York, NY 10011, USA;
| | - Paige Minchella
- Department of Molecular and Integrative Physiology, Kansas University Medical Center, Kansas City, KS 66160, USA;
| | - Sarah Ottum
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH 45267, USA;
| | - Christopher Walker
- Department of Gynecologic Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Jessica Rausch
- Department of Obstetrics and Gynecology, Hutzel Hospital, Detroit Medical Center, Detroit, MI 48201, USA;
| | - Conrad R. Chao
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Lawrence I. Grossman
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI 48201, USA; (N.P.); (L.I.G.); (S.A.)
| | - Siddhesh Aras
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI 48201, USA; (N.P.); (L.I.G.); (S.A.)
| | - Maurice-Andre Recanati
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 48201, USA
- Correspondence:
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11
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Lee SR, Kim JH, Lee YJ, Lee SW, Park JY, Suh DS, Kim DY, Kim SH, Kim YM, Kim YT. Single-Incision versus Multiport Robotic Myomectomy: A Propensity Score Matched Analysis of Surgical Outcomes and Surgical Tips. J Clin Med 2021; 10:jcm10173957. [PMID: 34501409 PMCID: PMC8432212 DOI: 10.3390/jcm10173957] [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: 06/14/2021] [Revised: 08/21/2021] [Accepted: 08/29/2021] [Indexed: 02/07/2023] Open
Abstract
We aimed to compare the perioperative outcomes of single-incision robotic myomectomy (SIRM) and multiport robotic myomectomy (MPRM) and provide surgical tips. We retrospectively analyzed the medical records of 462 patients with symptomatic leiomyoma who underwent MPRM or SIRM between March 2019 and April 2021. Demographic characteristics and surgical outcomes, including the total operative time (OT), estimated blood loss (EBL), and surgical complication rate, were compared between the two groups. Patients in the SIRM group had lower a body mass index and rate of previous pelvic surgery and were younger than those in the MPRM group. The myoma type was not different between groups; however, the MPRM group had larger, and more myomas than the SIRM group. After propensity score matching, these variables were not significantly different between the groups. The total OT, EBL, difference in hemoglobin levels, transfusion rate, and postoperative fever were not different between the groups. No postoperative complications occurred in the SIRM group. In the MPRM group, one patient needed conversion to laparotomy, and two patients had postoperative complications (umbilical incisional hernia and acute kidney injury). In conclusion, both MPRM and SIRM are feasible and effective surgical options for symptomatic myomas with cosmetic benefits and minimal risk of laparotomy conversion.
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Affiliation(s)
- Sa-Ra Lee
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
- Correspondence: ; Tel.: +82-2-3010-3648; Fax: +82-2-3010-3630
| | - Ju-Hee Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Jae Lee
- Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38, Bangdonggil, Sacheon-myeon, Gangneung-si 25440, Gangwon-do, Korea;
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Sung-Hoon Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, Seoul Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; (J.-H.K.); (S.-W.L.); (J.-Y.P.); (D.-S.S.); (D.-Y.K.); (S.-H.K.); (Y.-M.K.); (Y.-T.K.)
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12
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Uterine Fibroids and Infertility. Diagnostics (Basel) 2021; 11:diagnostics11081455. [PMID: 34441389 PMCID: PMC8391505 DOI: 10.3390/diagnostics11081455] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2–3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.
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13
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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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14
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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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15
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Silva AF, Silva ECCDA, Oliveira CN, Rocha KBF, Miguel MCC, Pereira JS. Oral and uterine leiomyomas exhibit high immunoexpression of Cripto-1 compared to normal myometrium. AN ACAD BRAS CIENC 2020; 92:e20200519. [PMID: 33331446 DOI: 10.1590/0001-3765202020200519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022] Open
Abstract
Leiomyomas are the most common benign tumors in women. Many of them are associated with significant morbidity. The present study aimed to analyze histomorphological and histochemical characteristics and immunoexpression of Cripto-1 in oral leiomyomas (OL), uterine leiomyomas (UL), and normal myometrium (NM). Sample was composed of ten OL, 11 UL and 11 NM. Histomorphological characteristics were analyzed at 100 and 400x magnifications with HE staining. The immunoexpression of Cripto-1 was analyzed in five high-power fields. Statistical analysis considered a significant difference when p<0.05. Six OL disclosed moderate/intense inflammatory infiltrate, while ten UL exhibited mild infiltrate (p=0.024). When analyzing all leiomyomas together, 20 exhibited hyalinization, whereas no NM exhibited this alteration (p<0.001). There was no statistical difference in the distribution of mast cells among the lesions. The median Cripto-1 was higher in UL (9.0), followed by OL and NM (4.0). Associations of the Cripto-1 expression between leiomyomas (separately and together) and NM were statistically significant (p<0.001). These results indicate that OL and UL exhibit similar histomorphological and histochemical characteristics, as well as differences to NM. The higher immunoexpression of Cripto-1 in leiomyomas compared to NM suggests that this protein may influence cell proliferation and tissue architecture of oral and uterine leiomyomas.
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Affiliation(s)
- AndrÉ F Silva
- Universidade Federal do Rio Grande do Norte, Departamento de Patologia, Rua General Gustavo Cordeiro de Farias, s/n, Petrópolis, 59012-570 Natal, RN, Brazil
| | - Emmily C C DA Silva
- Universidade Federal do Rio Grande do Norte, Departamento de Patologia, Rua General Gustavo Cordeiro de Farias, s/n, Petrópolis, 59012-570 Natal, RN, Brazil
| | - ClÁudia N Oliveira
- Universidade Federal do Rio Grande do Norte, Departamento de Patologia, Rua General Gustavo Cordeiro de Farias, s/n, Petrópolis, 59012-570 Natal, RN, Brazil
| | - Keyla B F Rocha
- Universidade Federal do Rio Grande do Norte, Departamento de Patologia, Rua General Gustavo Cordeiro de Farias, s/n, Petrópolis, 59012-570 Natal, RN, Brazil
| | - Marcia C C Miguel
- Programa de Pós-Graduação em Patologia Oral, Universidade Federal do Rio Grande do Norte, Rua Senador Salgado Filho, 1787, Lagoa Nova, 59056-000 Natal, RN, Brazil
| | - Joabe S Pereira
- Universidade Federal do Rio Grande do Norte, Departamento de Patologia, Rua General Gustavo Cordeiro de Farias, s/n, Petrópolis, 59012-570 Natal, RN, Brazil
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16
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Kobayashi Y, Tsuji K, Nakamura K, Nagai S, Takahashi T, Kobayashi A, Anko M, Hirano T, Watanabe K, Matoba Y, Kunitomi H, Adachi M, Yamagami W, Tominaga E, Banno K, Aoki D. Evaluation of safety and diagnostic performance for flexible hysteroscopy in 1591 outpatient cases. Jpn J Clin Oncol 2020; 50:1157-1161. [PMID: 32564088 DOI: 10.1093/jjco/hyaa098] [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: 01/28/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution's outpatient flexible hysteroscopy cases. METHODS A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012-2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates. RESULTS A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy. CONCLUSIONS Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.
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Affiliation(s)
- Yusuke Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kosuke Tsuji
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kanako Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Shimpei Nagai
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Takahashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Arata Kobayashi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Mayuka Anko
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Takuro Hirano
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Watanabe
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Matoba
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Haruko Kunitomi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masataka Adachi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Wataru Yamagami
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Eiichiro Tominaga
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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17
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Belilovets A, Gopal N, Stockwell E, Pedroso J, Brotherton J, Volker KW, Howard D. Patient Understanding of Uterine Fibroids and the Different Surgical Approaches to Hysterectomy. WOMEN'S HEALTH REPORTS 2020; 1:252-258. [PMID: 33786487 PMCID: PMC7784805 DOI: 10.1089/whr.2020.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
Objective: The purpose of this study was to assess understanding of the hysterectomy procedure and uterine fibroids among women in a general gynecology clinic. Materials and Methods: This was an anonymous cross-sectional survey. We adapted and pilot tested a survey instrument designed to assess understanding of the hysterectomy procedure and of uterine fibroids. The final version of the survey consisted of basic demographic questions, followed by 28 knowledge questions (Canadian Task Force Classification II-2). The survey was disseminated to women in the waiting room of one of our gynecology clinics. The patient population included women 18 years and older. Results: The mean age of respondents was 33.5 years old. In total, 69.5% of the respondents had at least some college education. In the group of questions related to different types of hysterectomies, the most poorly answered question was “Which type of hysterectomy has the highest risk of damage to the bladder?” Less than 40% of the respondents were able to identify a laparoscopic and robotic hysterectomy based on a written description. Of questions about uterine fibroids, the most poorly answered question was whether cancer that looks like fibroids is common, with >90% of the respondents incorrectly thinking that cancer that resembled fibroids is common. More than half of respondents did not know what a fibroid is. Conclusions: In this analysis of the understanding of the hysterectomy procedure and fibroids among an educated population, overall understanding was poor. Specific areas where knowledge was particularly poor were the different ways of doing a hysterectomy and uterine fibroids.
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Affiliation(s)
- Anastasia Belilovets
- Obstetrics and Gynecology, Sunrise Health Graduate Medical Education Consortium, Las Vegas, Nevada, USA
| | - Nithya Gopal
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada, USA
| | - Erica Stockwell
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada, USA.,Obstetrics and Gynecology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Jasmine Pedroso
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada, USA
| | - Joy Brotherton
- Obstetrics and Gynecology, Harbor-UCLA Medical Center, Torrance, California, USA.,Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - K Warren Volker
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada, USA.,Obstetrics and Gynecology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - David Howard
- Las Vegas Minimally Invasive Surgery/Women's Pelvic Health Center (A Davita Medical Group), Las Vegas, Nevada, USA.,Obstetrics and Gynecology, University of Nevada Las Vegas, Las Vegas, Nevada, USA
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18
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Gkegkes ID, Iatrakis G, Iavazzo PE, Bakalianou K, Iavazzo C. Robotic Management of Fibroids: Discussion of Use, Criteria and Advantages. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 63:63-66. [PMID: 32771070 DOI: 10.14712/18059694.2020.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fibroids are the most common benign tumors affecting fertility and quality of life. Different methods either definitive or fertility sparing are used for their management by using open, laparoscopic and robotic techniques. This is a narrative review presenting the role and the advantages of robotic surgery in fibroids (myomectomies or hysterectomies). Such a management is effective, safe and feasible in hands of well-trained teams even for multiple, large or deep located fibroids.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - George Iatrakis
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | | | - Konstadia Bakalianou
- Department of Obstetrics and Gynecology, General Hospital "Agia Olga", Athens, Greece
| | - Christos Iavazzo
- Gynaecological Oncology Department, Metaxa Cancer Hospital, Piraeus, Greece
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19
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Sanders AP, Norris S, Tulandi T, Murji A. Reproductive Outcomes Following Uterine Artery Occlusion at the Time of Myomectomy: Systematic Review and Meta-analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:787-797.e2. [DOI: 10.1016/j.jogc.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 10/25/2022]
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20
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Souftas V, Deuteraiou D, Anthoulaki X, Chalkidou A, Bothou A, Gaidatzi F, Tsypsianis G, Iatrakis G, Zervoudis S, Souftas D, Michalopoulos S, Vogiatzaki T, Galazios G, Nikolettos N, Tsikouras P. Significance of changes in inflammatory parameters following uterine artery embolization in pre-menopausal females. Exp Ther Med 2020; 19:3684-3690. [PMID: 32346432 PMCID: PMC7185183 DOI: 10.3892/etm.2020.8652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022] Open
Abstract
The purpose of the present study was to describe the course of changes in laboratory inflammatory markers following bilateral uterine artery embolization (UAE) as a treatment for leiomyomas and adenomyosis. The body temperature was measured and blood samples were collected to determine white blood cell (WBC) count and C-reactive protein (CRP) levels in 270 patients on the day prior to UAE and for up to 4 days post-embolization. Aside from a single case with a non-inflammatory complication, none of the other cases had any complications. Post-UAE leukocytosis with a mean maximum value of 10.8±3.5x109/l (range, 5.9-18.6x109/l) was observed one-year post-intervention. The mean leukocyte numbers were indicated to be higher on day 3 post-UAE. The CRP level was also increased post-UAE, with a mean maximum value of 7.75±3.5 mg/dl. Maximum levels were reached in 8 patients on the 2nd and in 11 patients on the 3rd post-operative day. The maximum pain score was ~5.5 and reached its lowest level at the end of the 12th week post-intervention. The present study did not consider an association between the embolic material used or uterus size with the level of treatment success. No complications were observed post-UAE; however, a significant increase in the WBC count was observed within the first 3 days, indicating mild leukocytosis.
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Affiliation(s)
- Vasileios Souftas
- Department of Interventional Radiology and Medical Imaging, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Dorelia Deuteraiou
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Xanthoula Anthoulaki
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Anna Chalkidou
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Anastasia Bothou
- Department of Obstetrics and Mastology, Rea Hospital, Athens 17564, Greece
| | - Fotini Gaidatzi
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Grigorios Tsypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Georgios Iatrakis
- University of West Attica, Department of Midwifery, Athens 17564, Greece
| | - Stefanos Zervoudis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Dimitrios Souftas
- Department of Social Administration, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Spyridon Michalopoulos
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Theodosia Vogiatzaki
- Department of Anesthesiology and Pain Treatment, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - George Galazios
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Nikolaos Nikolettos
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
| | - Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Medical Faculty, Democritus University of Thrace, Alexandroupolis 68100, Greece
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Chen WH, Huang KH, Kung FT. Effects of uterine artery occlusion during myomectomy on ovarian reserve: Serial follow-up of sex hormone levels, ultrasound parameters and Doppler characteristics. J Obstet Gynaecol Res 2020; 46:752-758. [PMID: 32153076 PMCID: PMC7317349 DOI: 10.1111/jog.14236] [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: 12/20/2019] [Accepted: 02/24/2020] [Indexed: 11/29/2022]
Abstract
AIM To evaluate the influence of uterine artery occlusion at myomectomy (UAO + M) on ovarian reserve based on serum sex hormone levels, ultrasound and color Doppler examinations. METHODS In this cohort study, nine women with symptomatic uterine myomas underwent UAO + M were recruited. Each woman was assessed preoperatively and 3, 6 months postoperatively, through a serial of hormonal, ultrasound parameters and Doppler examination for ovarian stromal blood flow. The data were analyzed using generalized estimating equations. RESULTS There was no significant difference in serum anti-Müllerian hormone (AMH) or follicle-stimulating hormone (FSH) levels before and 3, 6 months after UAO + M. The ovarian volume, antral follicle count (AFC) and ovarian stromal blood flow had significant changes in the right ovary. Ovarian volume and AFC significantly reduced at 3 months and recovered at 6 months postoperatively (P = 0.046, P = 0.019, respectively). Peak systolic velocity and end diastolic velocity significantly decreased at 3 months and leveled off at 6 months (P < 0.001, P = 0.001, respectively). Resistance index significantly increased at 3 months and decreased at 6 months (P = 0.037). A similar trend in ultrasound and Doppler findings was observed in the left ovary, but no statistical significance was found. CONCLUSION UAO + M had no detrimental effect on ovarian reserve 6 months postoperatively based on AMH and FSH levels. AFC, ovarian volume and stromal blood flow were transiently decreased in 3 months and recovered in 6 months.
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Affiliation(s)
- Wen-Hsin Chen
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Tsai Kung
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Xiamen Chang Gung Hospital, Xiamen, China
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22
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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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Tinelli A, Favilli A, Lasmar RB, Mazzon I, Gerli S, Xue X, Malvasi A. The importance of pseudocapsule preservation during hysteroscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2019; 243:179-184. [DOI: 10.1016/j.ejogrb.2019.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 11/29/2022]
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Huberlant S, Lenot J, Neron M, Ranisavljevic N, Letouzey V, De Tayrac R, Masia F, Warembourg S. Fertility and obstetrical outcomes after robot-assisted laparoscopic myomectomy. Int J Med Robot 2019; 16:e2059. [PMID: 31770474 DOI: 10.1002/rcs.2059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 09/30/2019] [Accepted: 10/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes. PATIENTS This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery. RESULTS Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%). Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported. CONCLUSION More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.
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Affiliation(s)
- Stéphanie Huberlant
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Juliette Lenot
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France.,Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Mathias Neron
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Noémie Ranisavljevic
- Department of Obstetrics and Gynecology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Vincent Letouzey
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Renaud De Tayrac
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Florent Masia
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France
| | - Sophie Warembourg
- Department of Obstetrics and Gynecology, University Hospital Caremeau, Nîmes, France.,Department of Obstetrics and Gynecology, Croix Rousse University Hospital (Hospices civils de Lyon), Lyon, France
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Dvorská D, Škovierová H, Braný D, Halašová E, Danková Z. Liquid Biopsy as a Tool for Differentiation of Leiomyomas and Sarcomas of Corpus Uteri. Int J Mol Sci 2019; 20:E3825. [PMID: 31387281 PMCID: PMC6695893 DOI: 10.3390/ijms20153825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Utilization of liquid biopsy in the management of cancerous diseases is becoming more attractive. This method can overcome typical limitations of tissue biopsies, especially invasiveness, no repeatability, and the inability to monitor responses to medication during treatment as well as condition during follow-up. Liquid biopsy also provides greater possibility of early prediction of cancer presence. Corpus uteri mesenchymal tumors are comprised of benign variants, which are mostly leiomyomas, but also a heterogenous group of malignant sarcomas. Pre-surgical differentiation between these tumors is very difficult and the final description of tumor characteristics usually requires excision and histological examination. The leiomyomas and malignant leiomyosarcomas are especially difficult to distinguish and can, therefore, be easily misdiagnosed. Because of the very aggressive character of sarcomas, liquid biopsy based on early diagnosis and differentiation of these tumors would be extremely helpful. Moreover, after excision of the tumor, liquid biopsy can contribute to an increased knowledge of sarcoma behavior at the molecular level, especially on the formation of metastases which is still not well understood. In this review, we summarize the most important knowledge of mesenchymal uterine tumors, the possibilities and benefits of liquid biopsy utilization, the types of molecules and cells that can be analyzed with this approach, and the possibility of their isolation and capture. Finally, we review the typical abnormalities of leiomyomas and sarcomas that can be searched and analyzed in liquid biopsy samples with the final aim to pre-surgically differentiate between benign and malignant mesenchymal tumors.
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Affiliation(s)
- Dana Dvorská
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Henrieta Škovierová
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Dušan Braný
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia.
| | - Erika Halašová
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
| | - Zuzana Danková
- Division of Oncology, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, 036 01 Martin, Slovakia
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Elkbuli A, Shaikh S, McKenney M, Boneva D. Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature. Int J Surg Case Rep 2019; 61:51-55. [PMID: 31326857 PMCID: PMC6642253 DOI: 10.1016/j.ijscr.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION While uterine leiomyomas are the most common pelvic tumors in females, resultant hemoperitoneum is an extremely rare and acute complication which requires emergent intervention and resuscitation. To date, less than one-hundred cases have been reported in the literature. PRESENTATION OF CASE We report a case of massive hemoperitoneum due to spontaneous rupture of a 20 cm pedunculated leiomyoma in a 74-year-old female who presented as a trauma alert. Rapidly declining hemodynamic status with an ultrasound consistent with extensive hemoperitoneum led to activation of the massive transfusion protocol and an emergent laparotomy. In the operating theater the laparotomy revealed 4 L of blood. She underwent a myomectomy and subsequently, an angiogram and embolization of a bleeding uterine artery. In all, she required transfusion of 26 units of blood. Post operatively she was discharged home on hospital day 13. DISCUSSION Near fatal hemoperitoneum secondary to a uterine leiomyoma may be due to traumatic or spontaneous rupture of an overlying vein or artery. Leiomyomas greater than 10 cm in size have an increased risk of rupturing. A significant amount of blood can accumulate in the peritoneum resulting in hypovolemic shock. CONCLUSION Acute complications of uterine leiomyomas requiring surgical intervention are exceptionally rare. Candidates for the massive transfusion protocol must be appropriately and timely identified. Additionally, because surgery is a potential treatment for hemorrhage control in leiomyoma-related hemoperitoneum, surgeons should be aware of such complications.
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Affiliation(s)
- Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.
| | - Saamia Shaikh
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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Cheng ICC, Li RK, Leung GPH, Li SL, Kong M, Lao LX, Zhang ZJ, Lin WL, Ng EHY, Rong JH, Chen JP, Su J, Zhang KYB, Meng W. Application of UPLC-MS/MS to simultaneously detect four bioactive compounds in the tumour-shrinking decoction (FM1523) for uterine fibroids treatment. PHYTOCHEMICAL ANALYSIS : PCA 2019; 30:447-455. [PMID: 30916852 DOI: 10.1002/pca.2827] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/30/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The Chinese medicine formulation, tumour-shrinking decoction (TSD, FM1523), which consists of 15 natural medicines, is used for uterine fibroids (UFs) therapy and possesses excellent clinical therapeutic effect. OBJECTIVE To develop a sensitive and validated analytical method for the simultaneous quantification of four crucial bioactive compounds including isorhamnetin-3-O-neohesperidoside, curcumin, peimine and tetrahydropalmatine in the principal formulation of this decoction. METHODS An ultra-performance liquid chromatography coupled tandem mass spectrometry (UPLC-MS/MS) with an electrospray ionisation (ESI) source in multiple reaction monitoring (MRM) mode was conducted to investigate these bioactive compounds in the TSD. The chromatographic separation was performed on a C18 column when the flow rate was adjusted at 0.2 mL/min with gradient elution of acetonitrile-water with 0.1% formic acid. Accelerated solvent extraction (ASE) method with higher extraction efficiency was employed for TSD sample pre-treatment. RESULTS The linearity, limit of detection (LOD) and limit of quantification (LOQ) were determined for this analytical method. The mean recoveries of the compounds were determined between 100.23% and 104.02% with satisfactory relative standard deviation (RSD) in the ranges of 2.65% to 3.81%. The precision was evaluated by intra-day and inter-day tests, which revealed RSD within the ranges of 1.21% to 2.14% and 1.24% to 2.32%, respectively. CONCLUSION The bioactive compounds of TSD samples were successfully quantified via UPLC-MS/MS with MRM mode. This study could help to evaluate the pharmacokinetic study of TSD during clinical applications and present a facile strategy for quantifying bioactive compounds in traditional Chinese Medicine decoction.
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Affiliation(s)
- Issac Chi-Chung Cheng
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ren-Kai Li
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - George Pak-Heng Leung
- Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Song-Lin Li
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Ming Kong
- Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Li-Xing Lao
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Zhang-Jin Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wai-Ling Lin
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ernest Hung-Yu Ng
- The Department of Obstetrics and Gynaecology, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Jian-Hui Rong
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jian-Ping Chen
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jing Su
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kalin Yan-Bo Zhang
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wei Meng
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- The Workstation for Training and Research (Hong Kong Branch) Yu Jin, Master of Gynecology of Chinese Medicine & Integrative Medicine, School of Chinese Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Giannini A, Bianchi M, Doria D, Fani S, Caretto M, Bicchi A, Simoncini T. Wearable haptic interfaces for applications in gynecologic robotic surgery: a proof of concept in robotic myomectomy. J Robot Surg 2019; 13:585-588. [PMID: 31062181 DOI: 10.1007/s11701-019-00971-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/01/2019] [Indexed: 11/24/2022]
Abstract
Uterine fibromatosis is common in women, with an estimated prevalence of up to 15-50% after 35 years. About 80% of women affected by fibromatosis have symptoms and require medical or surgical treatment. Nowadays, the gold standard for the surgical treatment of uterine fibromatosis is the use of minimally invasive surgery. The surgical skills and improvements offered by robotic approach can be relevant in reproductive surgery, in particular in minimally invasive myomectomy. However, the lack of tactile feedback of robotic platform is an important technical drawback that can reduce the accuracy of surgical procedures. Here, we present the design and the preliminary test of the wearable fabric, yielding display wearable haptic interfaces able to generate a real-time tactile feedback in terms of stiffness for applications in gynecologic robotic surgery. We preliminarily tested the device in the simulation of a real scenario of conservative myomectomy with the final purpose of increasing the accuracy and precision during surgery. The future goal is the integration of a haptic device with the commercially available robotic surgical systems with the purpose of improving the precision and accuracy of the surgical operation, thus allowing a better understanding concerning the anatomical relationship of the target structures. This in turn could determine a change in the surgical strategy in some cases, letting some patients selected for a demolitive approach retaining their uterus. This could improve surgical outcomes in fertile women enrolled for minimally invasive surgery for uterine fibroids and may be a facilitation for young gynecological surgeons or during residency teaching plans and learning programs.
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Affiliation(s)
- Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Matteo Bianchi
- Research Center "Enrico Piaggio", University of Pisa, Pisa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Davide Doria
- Research Center "Enrico Piaggio", University of Pisa, Pisa, Italy
| | - Simone Fani
- Research Center "Enrico Piaggio", University of Pisa, Pisa, Italy.,Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Antonio Bicchi
- Research Center "Enrico Piaggio", University of Pisa, Pisa, Italy.,Department of Information Engineering, University of Pisa, Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
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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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Moawad GN, Tyan P, Paek J, Tappy EE, Park D, Choussein S, Srouji SS, Gargiulo A. Comparison between single-site and multiport robot-assisted myomectomy. J Robot Surg 2019; 13:757-764. [DOI: 10.1007/s11701-019-00919-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/02/2019] [Indexed: 11/30/2022]
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Sheyn D, Bretschnieder CE, Mahajan ST, El-Nashar S, Billow M, Ninivaggio CS. Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40. J Minim Invasive Gynecol 2018; 26:1076-1082. [PMID: 30385429 DOI: 10.1016/j.jmig.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/19/2018] [Accepted: 10/20/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women. DESIGN A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2). SETTING American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016. INTERVENTIONS Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication. MEASUREMENTS AND MAIN RESULTS After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, p = .03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, p = .54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, p = .01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR] = 8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aOR = 5.91; 95% CI, 1.7-9.63), total operating time (aOR = 1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aOR = 3.67; 95% CI, 2.31-5.8). CONCLUSION LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata.
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Affiliation(s)
- David Sheyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar).
| | - C Emi Bretschnieder
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Sangeeta T Mahajan
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar)
| | - Sherif El-Nashar
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (Drs. Sheyn, Mahajan, and El-Nashar); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Megan Billow
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio); Case Western Reserve School of Medicine, Cleveland, Ohio (Drs. Bretschnieder, El-Nashar, and Billow)
| | - Cara S Ninivaggio
- Section of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio (Drs. Bretschnieder, Billow, and Ninivaggio)
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Singh SS, Belland L, Leyland N, von Riedemann S, Murji A. The past, present, and future of selective progesterone receptor modulators in the management of uterine fibroids. Am J Obstet Gynecol 2018; 218:563-572.e1. [PMID: 29274830 DOI: 10.1016/j.ajog.2017.12.206] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 12/12/2022]
Abstract
Uterine fibroids are common in women of reproductive age and can have a significant impact on quality of life and fertility. Although a number of international obstetrics/gynecology societies have issued evidence-based clinical practice guidelines for the management of symptomatic uterine fibroids, many of these guidelines do not yet reflect the most recent clinical evidence and approved indication for one of the key medical management options: the selective progesterone receptor modulator class. This article aims to share the clinical experience gained with selective progesterone receptor modulators in Europe and Canada by reviewing the historical development of selective progesterone receptor modulators, current best practices for selective progesterone receptor modulator use based on available data, and potential future uses for selective progesterone receptor modulators in uterine fibroids and other gynecologic conditions.
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Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy. Arch Gynecol Obstet 2018; 297:969-976. [PMID: 29417281 DOI: 10.1007/s00404-018-4697-5] [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: 05/24/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5-77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women. MATERIALS/METHODS The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study. RESULTS High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471). CONCLUSIONS It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.
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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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Shue S, Radeva M, Falcone T. Comparison of Long-Term Fertility Outcomes after Myomectomy: Relationship with Number of Myomas Removed. J Minim Invasive Gynecol 2018; 25:1002-1008. [PMID: 29371170 DOI: 10.1016/j.jmig.2018.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVE To determine if the number of myomas removed during myomectomy for symptomatic relief affects long-term fertility outcomes in reproductive-aged women. DESIGN Retrospective cohort survey study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS One hundred forty-four patients who underwent myomectomy for symptomatic myomas and attempted to conceive afterward. INTERVENTION Questionnaire mailed to reproductive-aged women who received robotic, laparoscopic, or abdominal myomectomy. MEASUREMENTS AND MAIN RESULTS Patients with >6 myomas removed were less likely to achieve pregnancy after myomectomy than patients with ≤6 myomas removed (22.9% vs 70.8%, respectively; p < .001). To achieve pregnancy, 45% of those with >6 myomas removed (vs 17.6% of those with ≤6 myomas removed) relied on fertility treatment (clomiphene citrate, letrozole, intrauterine insemination, or in vitro fertilization). Of those with >6 myomas removed who became pregnant, 45.5% had a term birth, 45.5% miscarried, and 9.1% had an ectopic pregnancy. Of those with ≤6 myomas removed who became pregnant, 61.8% had a term birth, 23.5% had a preterm birth, and 13.2% miscarried. CONCLUSION The number of myomas removed during myomectomy significantly affects fertility. Women with >6 myomas removed were less likely to become pregnant, more likely to require fertility treatment, and less likely to have a term birth when compared with women with ≤6 myomas removed.
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Affiliation(s)
- Shirley Shue
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Milena Radeva
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Tommaso Falcone
- Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio.
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Management considerations for patients with uterine fibroids and concurrent venous thromboembolism. Curr Opin Obstet Gynecol 2018; 28:329-35. [PMID: 27253238 DOI: 10.1097/gco.0000000000000286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The purpose is to provide an update on management strategies for uterine fibroids in the setting of venous thromboembolism (VTE). RECENT FINDINGS Uterine fibroids and VTE are independently associated with morbidity and increasing healthcare costs. Women with large uterine fibroids have a higher likelihood of VTE. Current strategies for stratifying patients with VTE take into account the nature of the VTE (i.e., truly provoked or unprovoked) and many patients may only require short-term anticoagulation. In those patients with risk factors for recurrent VTE, longer term anticoagulation may be required. SUMMARY In women with large uterine fibroids, the likelihood of concurrent VTE increases. Peri and postoperative management should be determined based on patient-specific risk stratification, with the majority of patients requiring short-term anticoagulation. Further risk stratification may be required for patients with essentially an unprovoked VTE, and consultation with a thrombosis specialist is recommended.
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Robot-assisted myomectomy. Best Pract Res Clin Obstet Gynaecol 2018; 46:113-119. [PMID: 29103894 DOI: 10.1016/j.bpobgyn.2017.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 09/11/2017] [Indexed: 12/11/2022]
Abstract
Uterine fibroids are the most common tumors of the uterus and the female pelvis and are associated with substantial morbidity for several women. In women with a wish to preserve fertility, a myomectomy is the surgical procedure of choice when medical therapy is inadequate. Despite evidence that minimally invasive surgery is preferable to laparotomy, most myomectomies are still performed by laparotomy. Robotic surgery was introduced to overcome some of the difficulties associated with laparoscopic surgery. A myomectomy is a suture-intensive surgery where the properties of a surgical robot have been suggested to be of particular value. Robotic myomectomy is feasible and safe, with similar outcome to laparoscopic surgery, although a robotic procedure is associated with a higher cost. The introduction of robotic surgery has expanded the indications for minimally invasive myomectomy to more complex cases previously performed by laparotomy. Randomized trials comparing different approaches to myomectomy are yet to be published. More studies are needed to determine the patients in whom a robotic approach is most beneficial, both in terms of patient outcomes and cost efficiency.
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Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296:709-720. [PMID: 28819682 DOI: 10.1007/s00404-017-4490-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/07/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE Uterine myomas are the main cause of benign uterine diseases in premenopausal women. Objective of the present paper is to investigate the current best treatment modalities of myomas, depending on age of the patient and her desire to preserve fertility, as well as on clinical presentation of this pathology, such as size, number, and location of fibroids and, furthermore, on surgical experience of the gynecologist. METHODS The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.
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Giannini A, Iodice V, Picano E, Russo E, Zampa V, Ferrari V, Simoncini T. Magnetic Resonance Imaging–Based Three Dimensional Patient-Specific Reconstruction of Uterine Fibromatosis: Impact on Surgery. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Andrea Giannini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
| | - Veronica Iodice
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Eugenia Picano
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
| | - Virna Zampa
- Diagnostic and Interventional Radiology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Vincenzo Ferrari
- EndoCAS, Center for Computer Assisted Surgery, University of Pisa, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, Italy
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Dvorská D, Braný D, Danková Z, Halašová E, Višňovský J. Molecular and clinical attributes of uterine leiomyomas. Tumour Biol 2017; 39:1010428317710226. [DOI: 10.1177/1010428317710226] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dana Dvorská
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
- Clinic of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Dušan Braný
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
- Clinic of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Zuzana Danková
- Division of Oncology, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Erika Halašová
- Division of Molecular Medicine, Biomedical Center Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jozef Višňovský
- Clinic of Gynecology and Obstetrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities. Med Sci (Basel) 2017; 5:medsci5020010. [PMID: 29099026 PMCID: PMC5635782 DOI: 10.3390/medsci5020010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 12/15/2022] Open
Abstract
Hysterectomy, the driving force for symptomatic uterine fibroids since 1895, has decreased over the years, but it is still the number one choice for many women. Since 1995, uterine artery embolization (UAE) has been proven by many researchers to be an effective treatment for uterine fibroids while allowing women to keep their uteri. The preponderance of data collection and research has focused on care quality in terms of efficiency and effectiveness, with little on location and viability related to care utilization, accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location. Data from National Hospital Discharge for 2004 through 2008 were accessed and analyzed for uterine artery embolization and hysterectomy. Frequency analyses were performed to determine distribution of variables by race/ethnicity, location, region, insurance coverage, cost and procedure. Based on frequency distributions of cost and length of stay, outliers were trimmed and categorized. Crosstabs were used to determine cost distributions by region, place/location, procedure, race, and primary payer. For abdominal hysterectomy, 9.8% of the sample were performed in rural locations accross the country. However, for UAE, only seven procedures were performed nationally in the same period. Therefore, all inferential analyses and associations for UAE were assumed for urban locations only. The pattern differed from region to region, regarding the volume of care (numbers of cases by location) and care cost. Comparing hysterectomy and UAE, the patterns indicate generally higher costs for UAE with a mean cost difference of $4223.52. Of the hysterectomies performed for fibroids on Black women in the rural setting, 92.08% were in the south. Overall, data analyzed in this examination indicated a significant disparity between rural and urban residence in both data collection and number of procedures conducted. Further research should determine the background to cost and care location differentials between races and between rural and urban settings. Further, factors driving racial differences in the proportions of hysterectomies in the rural south should be identified to eliminate disparities. Data are needed on the prevalence of uterine fibroids in rural settings.
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Uterine Fibroids in the Setting of Infertility: When to Treat, How to Treat? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0192-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Robotic-assisted laparoscopy in reproductive surgery: a contemporary review. J Robot Surg 2017; 11:97-109. [PMID: 28194637 DOI: 10.1007/s11701-017-0682-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Robotic surgery is a conceptual fusion of the conventional open surgery and the minimally invasive laparoscopic surgery. We reviewed the current role of robotic-assisted laparoscopy in the field of reproductive surgery by a literature search in PubMed database. We analyzed the reported advantages and limitations of the use of robotics in reproductive surgeries like myomectomy, tubal reanastomosis, endometriosis, ovarian tissue cryopreservation, and ovarian transposition. Overall, robotic assistance in reproductive surgery resulted in decreased blood loss, less post-operative pain, shorter hospital stay, and faster convalescence, whereas reproductive outcomes were similar to open/laparoscopic approaches. The main drawbacks of robotic surgery were higher cost and longer operating times. It is as safe and effective as the conventional laparoscopy and represents a reasonable alternate to abdominal approach. Procedures that are technically challenging with the conventional laparoscopy can be performed with robotic assistance. It has advantages of improved visualization and Endowrist™ movements allowing precise suturing. This helps to overcome the limitations of laparoscopy, especially in complicated procedures, and may shorten the steep learning curve in minimal invasive surgery. Randomized controlled trials looking at both short- and long-term outcomes are warranted to strengthen the role of robotic surgery in the field of reproductive surgery.
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Zhao X, Zeng W, Chen L, Chen L, Du W, Yan X. Laparoscopic Myomectomy Using "Cold" Surgical Instruments for Uterine Corpus Leiomyoma: A Preliminary Report. Cell Biochem Biophys 2016; 72:141-6. [PMID: 25490906 DOI: 10.1007/s12013-014-0425-3] [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] [Indexed: 10/24/2022]
Abstract
To assess the feasibility and safety of laparoscopic myomectomy without coagulation for uterine corpus leiomyoma between 4 and 9 cm in diameter with types 2-5. A total of 109 patients with uterine corpus myoma, single or multiple, between 4 and 9 cm in diameter with types from 2 to 5 were included who underwent laparoscopic myomectomy without using any unipolar or bipolar coagulation. Surgery time, intraoperative blood loss, hemoglobin decline on the first day after surgery and average days of post-operative hospitalization were recorded. The mean operative time was 70 ± 25 min (range 35-140 min). Mean blood loss during operation was 138 ml (range 20-400 ml), mean hemoglobin decline on the first day after surgery was 1.5 ± 0.75 g/dl (range 0-3.2 g/dl), and mean hospitalization time was 3.2 days (range 2-6 days). No patient required a blood transfusion. There were no major post-operative complications. Laparoscopic myomectomy without coagulation is feasible and safe for uterine corpus leiomyoma between 4 and 9 cm in diameter with types 2-5.
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Affiliation(s)
- Xiaofeng Zhao
- Department of Gynecology, Zhejiang Provincial People's Hospital, No. 158 Shangtang Rd, Hangzhou, 310004, China
| | - Wenjie Zeng
- Department of Gynecology, Zhejiang Provincial People's Hospital, No. 158 Shangtang Rd, Hangzhou, 310004, China
| | - Liyou Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, No. 158 Shangtang Rd, Hangzhou, 310004, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, No. 158 Shangtang Rd, Hangzhou, 310004, China
| | - Weijie Du
- Department of Gynecology, Zhejiang Provincial People's Hospital, No. 158 Shangtang Rd, Hangzhou, 310004, China
| | - Xiaojian Yan
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Shangcai Village South, Ouhai District, Wenzhou, 325000, China.
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Flyckt R, Soto E, Nutter B, Falcone T. Comparison of Long-Term Fertility and Bleeding Outcomes after Robotic-Assisted, Laparoscopic, and Abdominal Myomectomy. Obstet Gynecol Int 2016; 2016:2789201. [PMID: 28163718 PMCID: PMC5259613 DOI: 10.1155/2016/2789201] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 11/23/2022] Open
Abstract
Background/Aims. To compare long-term fertility and bleeding outcomes of women who underwent robotic-assisted, laparoscopic, and abdominal myomectomy at our institution over a 15-year period. Methods. This was a retrospective cohort study of myomectomy patients 18-39 years old that had surgery between January 1995 and December 2009 at our institution. Long-term follow-up on fertility and bleeding outcomes was collected from the patient directly. The uterine fibroid symptom and quality of life survey was also administered to assess current bleeding patterns. Baseline characteristics were compared across groups. Univariable comparisons of fertility and bleeding outcomes based on surgical approach were made using analysis of variance, Kruskal-Wallis analysis of ranks, and Chi-square tests as appropriate. Results. 134/374 (36%) subjects agreed to participate in the study. 81 subjects underwent an open procedure versus 28 and 25 subjects in the laparoscopic and robotic groups, respectively. Median follow-up after surgery was 8 years. 50% of patients desired pregnancy following surgery and, of those, 60% achieved spontaneous pregnancy; the spontaneous pregnancy rate did not differ between groups. Additionally, UFS-QOL scores and/or subscores did not differ between groups. Conclusion. There is no significant difference in long-term bleeding or fertility outcomes in robotic-assisted, laparoscopic, or abdominal myomectomy.
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Affiliation(s)
- Rebecca Flyckt
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Enrique Soto
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Benjamin Nutter
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tommaso Falcone
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
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Vargas MV, Moawad GN, Sievers C, Opoku-Anane J, Marfori CQ, Tyan P, Robinson JK. Feasibility, Safety, and Prediction of Complications for Minimally Invasive Myomectomy in Women With Large and Numerous Myomata. J Minim Invasive Gynecol 2016; 24:315-322. [PMID: 27939896 DOI: 10.1016/j.jmig.2016.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/04/2016] [Accepted: 11/30/2016] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess perioperative outcomes and identify predictors of complications for minimally invasive surgery (MIS) myomectomy in a cohort of women with large and numerous myomata. DESIGN Case-control study (Canadian Task Force classification II-2). SETTING Academic tertiary care medical center. PATIENTS Women undergoing MIS myomectomy performed by 3 high-volume surgeons between April 2011 and December 2014. INTERVENTIONS Characteristics were compared between women who experienced complications and those who did not. Factors predictive of complications were then identified. MEASUREMENTS AND MAIN RESULTS A total of 221 women underwent an MIS myomectomy, 47.5% via a laparoscopic approach and 52.5% via robotic surgery. The mean ± SD specimen weight was 408.1 ± 384.9 g, uterine volume was 586.1 ± 534.1 cm3, dominant myoma diameter was 9.6 ± 5.1 cm, and number of myomata removed was 4.5 ± 4.1. The most common complications were hemorrhage >1000 mL (8.6%) and blood transfusion (4.1%). The conversion rate was 1.8%. A dominant myoma diameter of ≥12 cm and a uterine volume of ≥750 cm3 increased the odds of complications (odds ratio [OR], 7.44; 95% confidence interval [CI], 2.03-31.84; p = .004 and OR, 6.15; 95% CI, 1.55-30.02; p = .014 respectively). A receiver operating characteristic curve considering dominant myoma diameter and uterine volume had an area under the curve of 0.81. A combination of dominant myoma diameter of ≥10 cm and uterine volume of 600 cm3 predicted complications with 79% sensitivity and 79% specificity. CONCLUSION Our cohort had large and numerous myomata with high specimen weights, but complications were comparable to those reported in previous studies of MIS myomectomy with less complex pathology. Hemorrhage and transfusion accounted for the majority of complications, and a combination of dominant myoma diameter and uterine volume was predictive of complications. Both factors can be easily defined before surgery and may be used to guide patient counseling, referrals, and implementation of preventative measures for hemorrhage and transfusion.
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Affiliation(s)
- Maria V Vargas
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Gaby N Moawad
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Cem Sievers
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Jessica Opoku-Anane
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Cherie Q Marfori
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Paul Tyan
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James K Robinson
- Department of Obstetrics and Gynecology, George Washington University Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
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Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation. Clin Obstet Gynecol 2016; 59:85-92. [PMID: 26670832 DOI: 10.1097/grf.0000000000000168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased awareness regarding risks associated with intracorporeal electromechanical, or power, morcellation has urged surgeons to develop alternative methods for tissue extraction that may mitigate some of these risks during surgery. The use of containment systems during laparoscopic procedures has allowed surgeons to continue to offer and perform myomectomies that still benefit from being minimally invasive but which may minimize the risk of inadvertent tissue dispersion. Here, we will review techniques for performing contained tissue fragmentation without the use of a power morcellator.
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Alkatout I, Mettler L, Günther V, Maass N, Eckmann-Scholz C, Elessawy M, Anapolski M. Safety and economical innovations regarding surgical treatment of fibroids. MINIM INVASIV THER 2016; 25:301-313. [DOI: 10.1080/13645706.2016.1190380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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50
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Abstract
A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately.
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Affiliation(s)
- Mayra J Thompson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce R Carr
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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