Isobaric two-port laparoscopic-assisted myomectomy by combined approach through umbilical and suprapubic mini-incisions with hidden scar: a technique and initial experience

Preliminary Analysis of Safety and Feasibility of a Single-Hole Laparoscopic Myomectomy via an Abdominal Scar Approach

Purpose

This paper aims to explore the safety and feasibility of a single-hole laparoscopic myomectomy through an abdominal scar approach.

Method

The clinical data of seven patients who underwent the single-hole laparoscopic myomectomy via the abdominal scar approach from January to November 2021 in the Department of Gynecology, the Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, were studied retrospectively. The duration of operation, the intraoperative blood loss, the decrease of postoperative hemoglobin, and the postoperative visual analogue score (0 points: no pain, 10 points: maximum pain) were recorded.

Results

All seven patients received the operation successfully, without changing to the conventional laparoscopic operation or open appendectomy. The average blood loss was 101.42 ± 7.89 ml, the average length of hospital stay was 5 ± 0.53 days, the average operation duration was 130 ± 26.86 min, and the 24-h pain score was 1.57 ± 0.53. The seven patients had no intraoperative or postoperative complications and no damage to the ureter or bladder. All patients could urinate spontaneously without urinary retention or urinary tract infection after catheter removal. No analgesic drugs were used after the operation.

Conclusion

The single-hole laparoscopic myomectomy via the abdominal scar approach is a more aesthetic and feasible option for eligible patients, but more cases and studies are needed for further confirmation.

Early identification of uterine scar defect by preconception magnetic resonance imaging to achieve successful pregnancy outcome after laparoscopic-assisted myomectomy: Two case reports

Myomectomy improves the reproductive ability of women. However, the risk for uterine rupture and abnormal placentation remains a concern. In two cases with scar defects after laparoscopic-assisted myomectomy, one case developed amniocele, while other case showed abnormally invasive placenta. Obstetrical management measures with cesarean sections yielded uneventful postoperative courses.

Response to comment on "Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation"

According to the literature review, CO2 insufflation on parasitic myoma implantation is not well studied, and we concur that our study is related to "Morcellation-induced parasitic myomas." We did not compare CO2 insufflation to non-insufflation in our study. The reason is the efficacy of gasless laparoscopic myomectomy and morcellation is not well established and this modality is seldom performed. Moreover, the effects of pneumoperitoneum on mesothelial cells and the role of the entire peritoneal cavity as a cofactor in adhesion formation have become well established, the role of CO2 insufflation in the establishment of parasitic myomas has not yet been studied. As such, more in-depth and well-designed studies for the role of CO2 insufflation are needed.

Hybrid laparoscopic myomectomy: A novel technique

The objective of this study was to report on a new surgical technique, hybrid laparoscopic myomectomy that integrates the advantages of transumbilical laparoendoscopic single-site surgery and those of isobaric laparoscopy, and the initial experience with 14 cases. All of the procedures were performed by a single surgeon who has over 18 years of experience in laparoscopic surgery and 4 years of experience in laparoendoscopic single-site surgery. All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure. The median operative time was 75 minutes (range, 30 to 100 minutes). No postoperative complication was observed. The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

Magnetic resonance imaging for diagnosis and management of unruptured interstitial pregnancy

AIM

The aim of this study was to evaluate the value of magnetic resonance imaging (MRI) for the diagnosis and management of suspicious unruptured interstitial pregnancy.

MATERIAL AND METHODS

Only patients with unruptured interstitial pregnancy evaluated by MRI and observed for at least a year after surgery were included. Initial evaluation was performed by measurement of serum β-human chorionic gonadotrophin level and ultrasonography. In suspicious cases, emergency MRI was performed to diagnose interstitial pregnancies with the exclusion of rudimentary horn pregnancy and angular pregnancy. Three-dimensional computed tomographic (CT) angiography was additionally performed if the uteroplacental neovascularization needed to be evaluated. Then, management procedures were individually determined along with the need for preoperative transcatheter arterial chemoembolization for immediate devascularization, and for the local or systemic administration of methotrexate. Either laparoscopic cornuostomy or cornual resection was chosen to excise the gestational mass.

RESULTS

Five consecutive women with unruptured interstitial pregnancy were enrolled. One case each of rudimentary horn pregnancy and angular pregnancy was excluded. Three-dimensional CT angiography was performed in three cases due to increased vascular flow on color Doppler ultrasonography. Preoperative devascularization by transcatheter arterial chemoembolization was performed in two cases, in which a prominent neovascularized gestational mass was identified. Uterine preservation was achieved by cornuostomy or cornual resection in all cases. Two patients with a desire to become pregnant conceived spontaneously thereafter, followed by successful cesarean birth.

CONCLUSION

This small case series emphasizes that precise localization of gestational products in the interstitial portion of the fallopian tube by MRI can facilitate the minimally invasive management of unruptured interstitial pregnancy for uterine preservation.