Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature

Vaginal Myomectomy for Large Intracervical Fibroids in Women Desirous of Preserving Their Uterus: A Case Series

Cervical fibroids are rare, benign tumors. The treatment of uterine fibroids is well-established, with standard treatment guidelines in place; however, there remains a lack of consensus on a standardized approach for cervical fibroids. A small prolapsing fibroid polyp may be removed vaginally, and a hysteroscope can be used in such cases to identify and ligate the pedicle. However, large cervical fibroids present a surgical challenge. Myomectomy is the cornerstone for the surgical management of cervical fibroids in women who wish to preserve their uterus. An enlarged cervix alters the anatomy of adjacent vital structures like the ureters, bladder, rectum, and uterine vessels, increasing the risk of injury to these structures. Due to the narrow operating field and the potential for injury, preoperative catheterization of the ureters through double-J (DJ) stenting is performed to delineate their course prior to surgery. Here, we report a series of cases in which intracervical fibroids, visible vaginally as a cervical protuberance, were enucleated vaginally using Bonney's principles. The base of the fibroid was clamped and ligated, followed by obliteration of the space and reconstruction of the cervix. Injection of vasopressin was unavailable in our resource-limited hospital; therefore, adrenaline was injected in a 1:200,000 dilution into the fibroid capsule intraoperatively to minimize blood loss. This method of enucleation minimizes the risk of injury to adjacent organs since the dissection occurs intracapsularly. Preoperative prophylactic DJ stenting was also not needed. Despite the lack of advanced medical options to reduce fibroid size and vascularity, such as preoperative gonadotropin-releasing hormone (GnRH) analogues and uterine artery embolization, in our low-resource setting, our technique of vaginal myomectomy effectively managed the challenges presented by large intracervical fibroids while preserving fertility. The only limitation was that fibroids that were not palpable through the cervical lips could not be enucleated using this approach.

Laparoscopic myomectomy for posterior cervical myoma: authors' experience and strategy

OBJECTIVES

Posterior cervical myoma poses a challenge for gynecologic surgeons, especially in women who want to preserve their fertility. The objective of this study is to summarize our experience with and strategy for this difficult situation.

METHODS

Between July 2019 and June 2021, 13 patients with posterior cervical myoma underwent laparoscopic myomectomy in our department. In addition to using the conventional strategy for laparoscopic myomectomy, other measures such as uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, were implemented to enhance safety and improve efficacy. The perioperative outcomes for these patients were retrospectively evaluated.

RESULTS

All surgeries were completed successfully with no conversion to laparotomy. There were no intraoperative complications or needs for blood transfusion. Uterine suspension was performed in all cases, while preliminary exposure of the uterine artery and ureter was performed in nine cases (69.2%). Uterine artery ligation was necessary in two cases. The mean surgical duration was 78.5 ± 12.3 minutes, mean blood loss was 54.2 ± 11.9 mL, and the mean specimen weight was 171.5 ± 59.8 g. Histopathologic analysis revealed leiomyomas in all cases. The postoperative course and follow-up were uneventful.

CONCLUSION

By uterine suspension and preliminary exposure of vital structures, including the uterine artery and ureter, laparoscopic myomectomy for posterior cervical myoma can be performed safely.

The effects of laparoscopic myomectomy and open surgery on uterine myoma patients' postoperative immuno-inflammatory responses, endocrine statuses, and prognoses: a comparative study

OBJECTIVE

To explore the effects of laparoscopic myomectomy and open surgery on the postoperative inflammatory responses, endocrine statuses, and prognoses of uterine myoma patients.

METHODS

Uterine myoma patients (n=126) admitted to the Department of Gynecology in our hospital were recruited as the study cohort and divided into an observation group (n=63), and a control group (n=63). The patients in the observation group underwent laparoscopic myomectomies, and the patients in the control group underwent open surgery. The completion times, intraoperative blood loss volumes, postoperative hospital stay durations, postoperative exhaust times, preoperative and postoperative immune function, inflammatory factors, sex hormone levels, postoperative complications, and prognoses were observed.

RESULTS

The observation group showed shorter hospital stays, lower intraoperative blood loss volumes, and shorter postoperative exhaust times (P<0.001). After the surgery, CD3⁺%, CD4⁺%, and CD4⁺%/CD8⁺% were decreased, but the CD8⁺% was increased in the two groups (all P<0.01). The observation group had higher CD3⁺%, CD4⁺% and CD4⁺%/CD8⁺%, and lower CD8⁺% than the control group (all P<0.001). The C-reactive protein, TNF-α, and IL-6 levels were higher after the surgery in the two groups (all P<0.05), but the observation group had lower levels (all P<0.001). The follicle-stimulating hormone and luteinizing hormone levels were lower, but the estradiol levels were higher in the observation group compared to the levels in the control group (all P<0.001). The total number of complications in the observation group was significantly lower than it was in the control group (P<0.05).

CONCLUSION

Laparoscopic myomectomy contributes to quick recoveries and short hospital stays, reduces the postoperative inflammatory response and immunosuppression, has little effect on the postoperative sex hormone levels, and has a low incidence of complications. It is worthy of clinical application.

Current Treatment Options for Cervical Leiomyomas: A Systematic Review of Literature

Background and objectives: Cervical leiomyomas are a rare benign disease. Although they are mainly treated surgically, currently, there is not a standardized treatment for cervical leiomyomas. This study aims to summarize current literature evidence about treatment options for cervical leiomyomas. Materials and methods: A systematic research of the literature was conducted in Scopus, PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, including observational prospective and retrospective studies, case series and case reports. We collected data regarding studies related to treatment options for cervical leiomyomas, evaluating the following aspects: study design, population, treatment type, rate of surgical complications, and fertility outcome. Results: According to literature research, 38 articles were included. Among 214 patients, the weighted average age was 39.4 years-old; 23 patients were pregnant. Most of the leiomyomas (78%) were extracervical; in 22% of cases (29 patients) were intracervical; 188 patients (88%) received surgical treatment, 6 (3%) received exclusive conservative management and 21 (10%) underwent interventional radiology treatment. One hundred twenty-seven patients (67.5%) underwent myomectomy, while 54 (28.7%) and 7 (3.7%) hysterectomy and trachelectomy, respectively. Cervical myomectomy was performed by open surgery in 21 out of 127 cases (16.5%), while in 92 (72.4%) and 6 (4.7%) patients the surgical approach was performed by traditional and robot-assisted laparoscopy, respectively. The total rate of surgical complications was 5.6%. Conclusion: Surgery is the primary therapeutic option for cervical leiomyomas with a low rate of surgical complications. Interventional radiology techniques have reported promising but still limited results.