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Farah-Gari Z, Khodja R, Lemkeddem Y, Zanoun N, Hadjar K, Agostini A. [Vaginal myomectomy: Feasibility and evaluation of the risk of postoperative adhesion]. ACTA ACUST UNITED AC 2020; 48:480-483. [PMID: 32278707 DOI: 10.1016/j.gofs.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this series are to evaluate the results of vaginal myomectomy and to assess the postoperative adhesion risk. METHODS It was a prospective observational study of fifty patients. All patients underwent a vaginal myomectomy, followed six months after laparoscopy to assess and treat postoperative adhesions. RESULTS Myomectomies were performed via an anterior, posterior and mixed colpotomy in 42 %, 54 % and 4 % of the cases, respectively. Laparoconversion was necessary in three cases (6 %). Laparoscopic evaluation was performed in 24 patients (48 %). adhesions were present in 14 cases (58.33 %); the adhesions did not affect the Fallopian tubes and ovaries. CONCLUSION Vaginal myomectomy was feasible, not limited to single myomectomy this which is in agreement with previously published series. Post adhesion risk seems weaker and does not concern the appendices, but this requires to be confirmed.
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Affiliation(s)
- Z Farah-Gari
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - R Khodja
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - Y Lemkeddem
- Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - N Zanoun
- service d'épidémiologie, CHU Lamine Debaghine, Boulevard Said Touati, Bab-el-oued, 16000 Alger; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - K Hadjar
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - A Agostini
- Service de gynécologie obstétrique, Hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
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Chatchotikawong U, Huang KG, Yantapant A. A Rare Isolated Vaginal Myoma. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2018.0031] [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)
- Usanee Chatchotikawong
- Department of Obstetrics and Gynecology, Gynecologic Oncology Division and Woman's Health Centre, Chulabhorn Hospital, and HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Kweishan, Taiwan
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Kweishan, Taiwan
- Chang Gung University College of Medicine, Tao-Yuan, Kweishan, Taiwan
| | - Aranya Yantapant
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
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Vaginal myomectomy for a thirteen-centimeter anterior myoma. Case Rep Obstet Gynecol 2013; 2013:285243. [PMID: 23662225 PMCID: PMC3639674 DOI: 10.1155/2013/285243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022] Open
Abstract
Vaginal myomectomy is an uncommon but advantageous approach for large interstitial uterine fibroids. Myomectomy is performed via laparotomy and laparoscopy; however, in selected cases, vaginal myomectomy has been proven to be a safe and an effective surgical procedure. We report the case of a 38-year-old para one woman with complaints of chronic lower abdominal pain. Preoperative workup revealed a thirteen-centimeter interstitial uterine myoma in the anterior wall. Successful myomectomy was performed via the vaginal route. We will share the preoperative images, operative technique, and postoperative images.
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Rolli R, Favilli A, Acanfora MM, Scuderi G, Di Renzo GC, Gerli S. Vaginal myomectomy is a safe and feasible procedure: a retrospective study of 46 cases. J Obstet Gynaecol Res 2012; 38:1201-5. [PMID: 22563644 DOI: 10.1111/j.1447-0756.2012.01852.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to establish the feasibility and safety of vaginal myomectomy via posterior colpotomy in a series of consecutive procedures performed by one surgeon. MATERIAL AND METHODS We conducted a retrospective study in a tertiary care university hospital, involving 46 patients with symptomatic myomas and uteruses smaller than 16 gestational weeks and with no signs of pelvic disease. After a presurgical study, the patients underwent vaginal myomectomy. Characteristics of patients, position and size of myomas, operative data, intraoperative and postoperative complications, and length of hospital stay were recorded. RESULTS Forty-four women underwent vaginal myomectomy and conversion to laparotomy was required in two cases (4.3%). Two patients suffered from infertility and one of these achieved pregnancy after the procedure. The median size of myomas was 50 mm (range 16-81). In two cases a culdoscopy was performed with a flexible fiberoptic gastroscope to better evaluate size and localization of myomas. Thirty-two patients underwent vaginal myomectomy under general anesthesia and 12 under locoregional anesthesia. The median vaginal operating time was 70 min (range 30-120). The estimated hemoglobin loss was 0.70 g/dL (range 0.40-3.35 g/dL). No severe intraoperative complications occurred. The median duration of hospital stay was 1 day (range 1-6). CONCLUSIONS Vaginal myomectomy is a safe and feasible surgical procedure if performed by a well-trained, experienced surgeon.
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Affiliation(s)
- Riccardo Rolli
- Department of Obstetrics and Gynecology, Ospedale Civile, Asiago, Italy
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Rovio PH, Heinonen PK. Pregnancy outcomes after transvaginal myomectomy by colpotomy. Eur J Obstet Gynecol Reprod Biol 2012; 161:130-3. [DOI: 10.1016/j.ejogrb.2011.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 11/12/2011] [Accepted: 12/06/2011] [Indexed: 10/28/2022]
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Benhidjeb T, Stark M. Natural Orifice Surgery (NOS)-the next step in the evolution of minimally invasive surgery. J Turk Ger Gynecol Assoc 2012; 13:56-60. [PMID: 24627676 DOI: 10.5152/jtgga.2012.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 12/06/2011] [Indexed: 12/21/2022] Open
Abstract
Endoscopy, which was introduced in the 20(th) century, changed the outcome of surgery by reducing the need for analgesia and shortening hospital stay. Any new surgical method should improve safety and outcome. At the beginning of the 21(st) century, the use of natural orifice surgery is a promising progress. The transgastric and transdouglas approaches are currently being investigated and evaluated. The transgastric approach still has a long way to go due to objective problems such as infections, stomach acidity, and the optimal way to ensure the safe closure of gastrotomy. The transdouglas approach, however, is already starting to establish itself and it seems that with the construction of designated instruments it will prevail in the 21(st) century.
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Affiliation(s)
- Tahar Benhidjeb
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany ; The New European Surgical Academy (NESA), Berlin, Germany
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
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Thomas B, Magos A. Subtotal hysterectomy and myomectomy - vaginally. Best Pract Res Clin Obstet Gynaecol 2010; 25:133-52. [PMID: 21185235 DOI: 10.1016/j.bpobgyn.2010.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/22/2010] [Accepted: 11/02/2010] [Indexed: 11/28/2022]
Abstract
Vaginal subtotal (or supracervical) hysterectomy and vaginal myomectomy are elegant procedures rarely carried out by the average gynaecologist. Both techniques, however, are easily learned, and in view of the proven advantages of vaginal surgery over abdominal or laparoscopic approaches, they are worthy of a wider application. Subtotal hysterectomy may be preferred to excision of the entire uterus in certain circumstances, and may be carried out vaginally. Vaginal myomectomy allows for a more thorough myomectomy and stronger uterine repair than a laparoscopic procedure, as well as avoiding abdominal wounds. It may represent the optimal approach where fibroids are favourably sited. We first set out the case for subtotal hysterectomy and then describe the development of vaginal subtotal hysterectomy and vaginal myomectomy. We discuss the evidence supporting their use and indications, and then describe techniques for both vaginal procedures.
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Affiliation(s)
- Benjamin Thomas
- Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK
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Faivre E, Surroca MM, Deffieux X, Pages F, Gervaise A, Fernandez H. Vaginal Myomectomy: Literature Review. J Minim Invasive Gynecol 2010; 17:154-60. [PMID: 20226401 DOI: 10.1016/j.jmig.2009.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/10/2009] [Accepted: 12/15/2009] [Indexed: 11/17/2022]
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Wen KC, Sung PL, Chao KC, Lee WL, Liu WM, Wang PH. A prospective short-term evaluation of uterine leiomyomas treated by myomectomy through conventional laparotomy or ultraminilaparotomy. Fertil Steril 2008; 90:2361-6. [DOI: 10.1016/j.fertnstert.2007.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 09/29/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
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Agostini A, Gerbeau S, Al Nakid M, Ronda I, Cravello L, Blanc B. Complications of vaginal myomectomy by posterior colpotomy. Eur J Obstet Gynecol Reprod Biol 2008; 138:100-4. [DOI: 10.1016/j.ejogrb.2007.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 05/11/2007] [Accepted: 06/19/2007] [Indexed: 11/15/2022]
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Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2007; 89:1-16. [PMID: 18155200 DOI: 10.1016/j.fertnstert.2007.09.069] [Citation(s) in RCA: 269] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 09/10/2007] [Accepted: 09/10/2007] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the current understanding of the role the uterus plays in embryo implantation and to outline congenital anomalies and acquired diseases that impact normal uterine function. DESIGN The publications related to the embryo implantation, Mullerian anomalies, uterine polyps, uterine synechiae, and myomas were identified through Medline and reviewed. CONCLUSION(S) Congenital anomalies and acquired diseases of the uterus may negatively impact on the complex processes of embryo implantation. Hysteroscopic surgery to correct uterine septa, intrauterine synechiae, and myomas that distort the uterine cavity may benefit women with infertility or recurrent pregnancy loss. The effect of endometrial polyps on fertility is uncertain, but their removal, once identified, is justifiable. Complex congenital anomalies such as unicornuate uterus and uterus didelphys may negatively affect fertility and pregnancy outcome, and surgical treatment may benefit select patients.
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Affiliation(s)
- Elizabeth Taylor
- Department of Obstetrics and Gynecology, University of British Columbia, BC Women's Hospital and Women's Health Centre,Vancouver, British Columbia, Canada.
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12
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Benhidjeb T, Witzel K, Bärlehner E, Stark M. [The natural orifice surgery concept. Vision and rationale for a paradigm shift]. Chirurg 2007; 78:537-42. [PMID: 17492263 DOI: 10.1007/s00104-007-1346-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND During the 20th Century, laparoscopic surgery achieved high standards and significantly reduced morbidity. In order to make surgery simpler and safer, a new concept, natural orifice surgery (NOS), has recently been introduced. The approach to the abdominal cavity may be transoral-transgastric, transvaginal-transdouglas or transanal-transrectal. This article describes the logic behind this approach and the expected challenges. METHODS In order to realize this goal, we founded the first European based working group on NOS. This group concentrates on the development of transdouglas procedures in women by using the transdouglas endoscopic device (TED). This is a wide, multi-channel instrument, which will enable surgery to be performed via a single entry. RESULTS Simulation of various intra-abdominal operations, such as staging, cholecystectomy, appendectomy, myomectomy und ovarectomy, using TED has already been carried out. Practical studies are planned in the near future. CONCLUSION The feasibility of NOS has been demonstrated in various experimental studies. We believe that this technique will create a spectrum of innovative and high quality operations and will improve patient safety.
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Affiliation(s)
- T Benhidjeb
- The New European Surgical Academy (NESA), Berlin-Buch.
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13
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Liu WM, Wang PH, Chou CS, Tang WL, Wang IT, Tzeng CR. Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas. Fertil Steril 2007; 87:356-61. [DOI: 10.1016/j.fertnstert.2006.07.1497] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Revised: 07/04/2006] [Accepted: 07/04/2006] [Indexed: 11/16/2022]
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Rovio PH, Heinonen PK. Transvaginal myomectomy with screw traction by colpotomy. Arch Gynecol Obstet 2005; 273:211-5. [PMID: 16208477 DOI: 10.1007/s00404-005-0078-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 09/02/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate the clinical effectiveness and safety of the enucleation of uterine leiomyomas by traction method via colpotomy. METHODS Ten women with menorrhagia, pelvic pain, or secondary infertility associated with single uterine myomas underwent transvaginal myomectomy with screw traction by colpotomy. The feasibility of the procedure, operative complications, postoperative recovery, pregnancies, and relief of symptoms were the main outcome measures. RESULTS Traction myomectomy was completed vaginally in all patients. The mean operating time was 71 min and average blood loss 385 ml. The mean size of a single myoma was 6.7 cm (range 5.6-8.0 cm) and weight 153 g. One patient developed a transient hematoma. All women reported relief of their symptoms after a mean follow-up of 24 months. Three patients had a term delivery postoperatively. CONCLUSIONS Traction myomectomy by colpotomy is a feasible approach for selected patients wishing to preserve their ability to conceive. A single well-lined myoma of 5-8 cm diameter and possible to reach via colpotomy is a suitable subject for the procedure, which proved a viable surgical approach.
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Affiliation(s)
- Päivi H Rovio
- Department of Obstetrics and Gynecology, Tampere University Hospital and Medical School/K-210, 33014, Tampere, Finland
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Wang CJ, Yuen LT, Lee CL, Yen CF, Soong YK. Laparoscopic-assisted vaginal subtotal hysterectomy. J Laparoendosc Adv Surg Tech A 2005; 15:33-7. [PMID: 15772474 DOI: 10.1089/lap.2005.15.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A novel approach in combined laparoscopic and vaginal procedures through the posterior cul-de-sac for subtotal hysterectomy is introduced. PATIENTS AND METHODS Twenty-one women with menometrorrhagia, symptomatic adenomyosis, or uterine myomas were enrolled in this study. After laparoscopic dissection of bilateral round ligaments and adnexa, a guiding suture brought the uterine fundus down through the posterior cul-desac into the vagina via a posterior colpotomy. Subtotal hysterectomy and hemostasis of the cervical stump were then performed transvaginally by conventional techniques and equipment. RESULTS Mean operative time, blood loss, and length of hospital stay were 111.2 +/- 28.8 minutes, 252.4 +/- 147.9 mL, and 3.2 +/- 0.9 days, respectively. No patients developed serious complications, but 1 patient had a postoperative stump infection and was treated with 2 combined antibiotics, uneventfully. CONCLUSION A combined laparoscopic and vaginal approach in performing subtotal hysterectomy through the posterior cul-de-sac is an alternative to a purely laparoscopic approach.
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Affiliation(s)
- Chin-Jung Wang
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
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Banu NS, Manyonda IT. Alternative medical and surgical options to hysterectomy. Best Pract Res Clin Obstet Gynaecol 2005; 19:431-49. [PMID: 15985257 DOI: 10.1016/j.bpobgyn.2005.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The range of alternatives to hysterectomy includes 'expanded' oral medical regimens, the levonorgestrel-releasing intrauterine system (LNG-IUS), a wide range of endometrial ablative techniques, and-where fibroids are the primary pathology-myomectomy and uterine artery embolization. Since research has shown that hysterectomy is a highly effective treatment, these alternatives must be assessed against the recognized high satisfaction rates and improved quality of life reported following hysterectomy. Additional issues that would also need to be addressed include complication rates, side-effects, and cost-effectiveness. For women with prolonged abnormal uterine bleeding, recent research suggests that hysterectomy is significantly superior to an expanded medical treatment regimen for health-related quality-of-life measures. Satisfaction with treatment, and health-related quality of life and psychosocial well-being, are reportedly similar between hysterectomy and the LNG-IUS, but the latter has the advantage of reduced cost. Endometrial ablation reduces menstrual blood flow, but its benefits relative to hysterectomy lessen over time. No large-scale studies have adequately compared uterine artery embolization or myomectomy to hysterectomy. Perhaps the most telling finding from recent research with respect to the place of alternative therapies to hysterectomy is that the existence or advent of these alternatives has not reduced hysterectomy rates, but merely increased treatment options and interventions for excessive menstrual loss.
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Affiliation(s)
- Nassera S Banu
- Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK
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Agostini A, Deval B, Birsan A, Ronda I, Bretelle F, Roger V, Cravello L, Madelenat P, Blanc B. Vaginal myomectomy using posterior colpotomy: feasibility in normal practice. Eur J Obstet Gynecol Reprod Biol 2004; 116:217-20. [PMID: 15358468 DOI: 10.1016/j.ejogrb.2003.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 11/25/2003] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myomectomy is classically performed via laparotomy. Endoscopic surgery is limited for some indications. Vaginal myomectomy is a surgical procedure that has recently been evaluated. The aim of this study was to evaluate the feasibility, reproducibility and complication rate of vaginal myomectomy via posterior colpotomy. METHODS A retrospective study was performed from November 1998 to February 2001 in three departments of gynaecology. RESULTS Forty-five patients were involved, 17 (37.8%) of whom underwent laparoscopy before vaginal myomectomy for evaluation or treatment of a second pelvic disorder. Myomectomy was performed vaginally in 40 (89%) of the 45 patients. Peroperative laparotomy was required in five patients (11%), either because vaginal myomectomy proved impossible (four cases) or because of rectal injury (one case). One patient needed supplementary laparotomy on day 8 for the treatment of a pelvic abscess. CONCLUSION Posterior vaginal myomectomy seems to be a feasible and reproducible surgical procedure. The success rate of vaginal myomectomy in this study was over 80%. Further randomised studies are needed to compare this procedure with laparotomy and laparoscopy.
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Affiliation(s)
- Aubert Agostini
- Department of Obstetrics & Gynaecology B, La Conception Hospital, 147 Boulevard Baille, 13385 Marseille Cedex 05, France.
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Abstract
Hysteroscopic myomectomy is a minimally invasive technique that eliminates the need for a laparotomy and is associated with lower morbidity than abdominal myomectomy. Its beneficial effects are reflected by the improvement in menstrual pattern, fertility rate, and overall patient satisfaction. It is usually performed as outpatient surgery but occasionally requires an overnight stay. Most patients return to full activity within 48 hours. To exploit the full potentials of this procedure, appropriate case selection and surgical expertise are essential. It should be considered as first-line conservative surgical therapy for the management of symptomatic intracavitary fibroids.
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Affiliation(s)
- Neelam Batra
- Department of Obstetrics and Gynaecology Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK
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20
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Chin HY, Lee CL, Yen CF, Wang CJ, Soong YK. Laparoscopic-Assisted Vaginal Myomectomy Through an Anterior Approach. J Laparoendosc Adv Surg Tech A 2004; 14:135-8. [PMID: 15245664 DOI: 10.1089/1092642041255432] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of a combined laparoscopic and vaginal approach through the anterior cul-de-sac in dealing with fundal and/or anterior wall uterine myomata. PATIENTS AND METHODS Seven women with symptomatic fundal and/or anterior wall uterine myomata were enrolled in this study. After laparoscopic identification of the location of the myomata, a guiding suture brought the dominant myoma down through the anterior cul-de-sac into the vagina via an anterior colpotomy. Resection and suturing were then performed transvaginally. RESULTS Mean +/- standard deviation (SD) operative time, blood loss, and the length of hospital stay were 88.1 +/- 27.8 minutes, 278.6 +/- 131.8 mL, and 2.9 +/- 0.7 days, respectively. No patients developed serious complications, and only four transient macroscopic hematuria occurred intra- and postoperatively. CONCLUSION Although transient hematuria may occur, a combined laparoscopy and vaginal approach in dealing with fundal and/or anterior wall uterine fibroids through the anterior cul-de-sac is an alternative to pure laparoscopic myomectomy.
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Affiliation(s)
- Hung-Yen Chin
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
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Manyonda I, Sinthamoney E, Belli AM. Controversies and challenges in the modern management of uterine fibroids. BJOG 2004; 111:95-102. [PMID: 14723744 DOI: 10.1046/j.1471-0528.2003.00002.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Isaac Manyonda
- Department of Gynaecology, St George's Healthcare NHS Trust, London, UK
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Frederick J, Hardie M, Reid M, Fletcher H, Wynter S, Frederick C. Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study. Hum Reprod 2002; 17:2967-71. [PMID: 12407058 DOI: 10.1093/humrep/17.11.2967] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up. RESULTS The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.
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Affiliation(s)
- J Frederick
- Department of Obstetrics, Gynaecology and Child Health, University Hospital of the West Indies, Kingston 7, Jamaica, WI.
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Wang CJ, Yen CF, Lee CL, Soong YK. Laparoscopic-assisted vaginal myomectomy. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000; 7:510-4. [PMID: 11044502 DOI: 10.1016/s1074-3804(05)60364-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To evaluate the safety and efficacy of combined laparoscopic and vaginal approach in dealing with uterine myomas. DESIGN Retrospective case study (Canadian Task Force classification II-2). SETTING Tertiary care major teaching hospital. PATIENTS Thirty-one women with symptomatic fundal and/or posterior wall uterine myomas. INTERVENTION Laparoscopic-assisted vaginal myomectomy performed by one of the authors from July 1996 to December 1998. MEASUREMENTS AND MAIN RESULTS Mean +/- SD operating time, blood loss, and length of hospital stay were 79.19+/-18.31 minutes, 150.00+/- 103.28 ml, and 3.10+/-0.75 days, respectively. No patients developed serious complications, and only two minor complications occurred. CONCLUSION After laparoscopic inspection and location of uterine myomas, dealing with posterior and fundal uterine myomas by the vaginal route makes hemostasis and uterine repair easier than by purely laparoscopic approach.
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Affiliation(s)
- C J Wang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu-Hsin Street, Kwei-Shan Tao-Yuan, Taiwan
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Li TC, Mortimer R, Cooke ID. Myomectomy: a retrospective study to examine reproductive performance before and after surgery. Hum Reprod 1999; 14:1735-40. [PMID: 10402378 DOI: 10.1093/humrep/14.7.1735] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this retrospective study was to establish the impact of myomectomy on pregnancy outcome with particular reference to its effect on the incidence of pregnancy loss. Myomectomy was performed using microsurgical procedures upon 51 women who had intramural or subserosal fibroids and wished to conceive. Overall, the conception rate following myomectomy was 57%. Multiple regression analysis showed that age was the only factor which influenced conception rate: </=35 years, 74% (23/31); >/=36 years, 30% (6/20; P < 0.005). The pregnancy loss rate prior to myomectomy was 60% (24/40), which was reduced to 24% (8/33) after myomectomy (P < 0.001). There was no instance of premature labour or scar rupture among 25 live births. This retrospective study suggests that myomectomy for intramural and subserosal fibroids may significantly improve the reproductive performance of women presenting with infertility or pregnancy loss.
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Affiliation(s)
- T C Li
- Jessop Hospital for Women, Leavygreave Road, Sheffield S3 7RE, UK
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Davies A, Hart R, Magos AL. The excision of uterine fibroids by vaginal myomectomy: a prospective study. Fertil Steril 1999; 71:961-4. [PMID: 10231066 DOI: 10.1016/s0015-0282(99)00061-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness and safety of the excision of uterine fibroids by vaginal myomectomy. DESIGN Prospective study. SETTING A gynecology department of a university teaching hospital. PATIENT(S) Women with menorrhagia, pelvic pain, symptoms of pressure, or subfertility attributable to moderate-sized uterine fibroids who otherwise would have required abdominal or laparoscopic myomectomy. INTERVENTION(S) Vaginal myomectomy. MAIN OUTCOME MEASURE(S) The feasibility of vaginal surgery, operative complications, postoperative recovery, and relief of symptoms. RESULT(S) Myomectomy was completed vaginally in 32 (91.4%) of 35 patients and none required hysterectomy. The overall operating time was 78 minutes, the estimated operative blood loss was 313 mL, and the mean postoperative hospital stay was 4 days. Pelvic hematomas developed in 4 patients, and one colpotomy required resuture. Seventy-four percent of the women reported relief of their symptoms at 3 months' follow-up. Three patients have had full-term pregnancies since the operation. CONCLUSION(S) Myomectomy can be performed by the vaginal route in selected cases with low morbidity and a good short-term success rate. Unlike open myomectomy, it requires no skin incision, and unlike laparoscopic myomectomy, it can be used in patients who have numerous, relatively large, and intramural fibroids.
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Affiliation(s)
- A Davies
- Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London, United Kingdom
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Davies A, Magos AL. Indications and alternatives to hysterectomy. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1997; 11:61-75. [PMID: 9155936 DOI: 10.1016/s0950-3552(97)80050-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hysterectomy is the commonest major operation performed by gynaecologists and is the definitive cure for many of it's indications which include dysfunctional uterine bleeding, fibroids, utero-vaginal prolapse, endometriosis and adenomyosis, pelvic inflammatory disease, pelvic pain, gynaecological cancers and obstetric complications. It is a successful operation in terms of relieving women of their presenting symptoms and high levels of satisfaction are reported by patients. However, it has a high risk of complications, involves a prolonged convalescence, is expensive and to some women represents a loss of femininity. It should only be employed after trying conservative treatments first if appropriate. If this fails, currently only endometrial ablation and myomectomy are valid alternatives to hysterectomy. If ultimately hysterectomy is required, there is considerable evidence that patient care can be improved by increasing the proportion of operations that are done vaginally and laparoscopically and decreasing the number of laparotomies.
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Affiliation(s)
- A Davies
- Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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