Comparison of safety and efficacy between laparoscopic myomectomy and traditional laparotomy for patients with uterine fibroids and their effect on pregnancy rate after surgery

Application of high intensity focused ultrasound in the treatment of uterine fibroids in overweight/obese women

OBJECTIVE

To investigate the clinical efficacy and safety of High-Intensity Focused Ultrasound (HIFU) in the treatment of uterine fibroids in overweight/obese women.

METHODS

A retrospective analysis was conducted on the clinical data of 155 overweight/obese women with uterine fibroids treated at our hospital between January 2022 and January 2024. Among them, 75 patients underwent HIFU treatment (observation group), while 80 patients received conventional laparoscopic myomectomy (control group). Perioperative indicators, symptom improvement (assessed by the Symptom Severity Score, SSS), health-related quality of life (HRQL score), complications, and recurrence rates at 1-year post-treatment were compared between the two groups.

RESULTS

All procedures were successfully completed in both groups. No significant differences were observed in baseline characteristics such as age, BMI, number of fibroids, maximum fibroid diameter, and hemoglobin levels between the two groups (P > 0.05). At 6 months and 1 year post-treatment, the observation group showed significantly better SSS scores (12.61 ± 1.22 vs. 15.89 ± 1.21; 10.40 ± 1.27 vs. 12.03 ± 1.33) and HRQL scores (89.35 ± 1.90 vs. 84.69 ± 1.24; 94.19 ± 1.16 vs. 91.69 ± 1.32) compared to the control group (P < 0.05). The total complication rate in the observation group was significantly lower than that in the control group (9.33% vs. 21.3%, χ² = 4.34, P = 0.04). No recurrence or fibroid enlargement was observed in the observation group at 1-year follow-up.

CONCLUSION

HIFU is an effective and safe treatment for uterine fibroids in overweight/obese women, offering advantages such as minimal invasiveness, fewer complications, and faster recovery. It represents a superior minimally invasive option for this patient population.

Comparison of uterine myometrial thickness at the site of myomectomy scar after surgery using laparoscopic and laparotomy methods

Fibroids are the most common benign tumours of the uterus, often requiring surgery when symptomatic. This study aims to investigate the impact of surgery using two methods, laparoscopy and laparotomy, on the thickness and vascularity of the uterine myometrium at the site of myomectomy scar (comparing sonographic features at the surgical scar site, including thickness, vascularity, and the extent of fibrotic tissue, in both open and laparoscopic surgical approaches). In this clinical trial, 100 women with type 2-5 fibroids and clinical symptoms, seeking surgery et al. Zahra Hospital, were enrolled in two groups: laparoscopy and laparotomy. Inclusion criteria were a maximum fibroid size of 8 cm and, in the case of multiple fibroids, a maximum of three, with the largest being 8 cm. 6 months post-surgery, sonographic assessments of the myomectomy scar site were compared between both groups. Participants showed no significant differences in demographic and obstetric factors. The most common clinical symptom (87%) in both groups was abnormal uterine bleeding (AUB). The mean hospital stay duration was statistically significantly lower in the laparoscopy group at 1.64 (SD 0.56) compared to 1.89 (SD 0.58) in the laparotomy group (p = 0.028). Additionally, the decrease in haemoglobin levels was 0.89 (SD 0.92) and 1.87 (SD 2.24) units, respectively, which showed a statistically significant difference (p = 0.003). The duration of surgery was significantly shorter in the laparotomy group (p = 0.001). Abdominal pressure was not observed in the laparoscopy group, while 12% of the laparotomy group reported complaints (p = 0.013). Based on the results obtained in this study, it can be concluded that there was no difference between these two methods in terms of improving uterine thickness and associated complications. However, the decrease in haemoglobin levels and the length of hospital stay were lower in patients undergoing laparoscopy.

Uterine Leiomyoma Journey With Acessa ProVu System Using General Anesthesia Under Laparoscopic Ultrasound Guidance: A Case Report

This case report details the evaluation and management of a 40-year-old woman presenting with heavy menstrual bleeding and severe dysmenorrhea. Despite three months of combined oral contraceptives, symptoms persisted. The patient denied other systemic symptoms, with no weight loss, fatigue, or urinary/fecal symptoms. No visual, cardiovascular, pulmonary, abdominal, neurological, or mental health issues were reported. Pelvic imaging revealed a 7 cm × 4.3 cm FIGO 4 fibroid. The chosen treatment was laparoscopic radiofrequency ablation (Acessa) due to its efficacy, safety, and faster recovery. The case highlights the importance of a comprehensive approach to diagnosing and treating abnormal uterine bleeding.