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Lee N, Choi SH, Won S, Jung YW, Kim SH, Lee JY, Lim CK, Yang JB, Ha JG, Seong SJ. Comparison of Surgical Outcomes of Two New Techniques Complementing Robotic Single-Site Myomectomy: Coaxial Robotic Single-Site Myomectomy vs. Hybrid Robotic Single-Site Myomectomy. J Pers Med 2024; 14:439. [PMID: 38673066 PMCID: PMC11050827 DOI: 10.3390/jpm14040439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to compare surgical outcomes between two new robotic single-site myomectomy (RSSM)-complementary techniques: coaxial robotic single-site myomectomy (Coaxial-RSSM) and hybrid robotic single-site myomectomy (Hybrid-RSSM). METHODS Medical records for 132 women undergoing Coaxial-RSSM and 150 undergoing Hybrid-RSSM, consecutively, were retrospectively reviewed. Patient characteristics and surgical outcomes were assessed and compared after propensity score matching (PSM). RESULTS In the outcomes of PSM, the Coaxial-RSSM group showed significantly reduced blood loss (79.71 vs. 163.75 mL, p < 0.001) and reduced hospital duration (4.18 ± 0.62 vs. 4.63 ± 0.90) relative to the Hybrid-RSSM group. Conversely, Hybrid-RSSM allowed for a shorter operative time compared with Coaxial-RSSM (119.19 vs. 156.01 min, p = 0.007). No conversions to conventional laparoscopy or laparotomy or any need for the multi-site robotic approach occurred in either group. Postoperative complications, including ileus, fever, and wound dehiscence, showed no statistically significant differences between the two groups. CONCLUSIONS Blood loss was lower with Coaxial-RSSM, and operative time was shorter for Hybrid-RSSM. A follow-up prospective study is warranted for more comprehensive comparison of surgical outcomes between the two techniques.
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Affiliation(s)
- Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Su-Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Yong-Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
| | - Seung-Hyun Kim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jin-Yu Lee
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Chul-Kwon Lim
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Jung-Bo Yang
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Joong-Gyu Ha
- Department of Obstetrics and Gynecology, Eulji University Hospital, Eulji University School of Medicine, 95 Dunsanseo-ro, Seo-gu, Daejeon 35233, Republic of Korea; (S.-H.K.); (J.-Y.L.); (C.-K.L.); (J.-B.Y.)
| | - Seok-Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06135, Republic of Korea; (N.L.); (S.-H.C.); (S.W.); (Y.-W.J.)
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Flaxman TE, Cooke CM, Miguel OX, Sheikh A, McInnes M, Duigenan S, Singh SS. The Value of Using Patient-Specific 3D-Printed Anatomical Models in Surgical Planning for Patients With Complex Multifibroid Uteri. J Obstet Gynaecol Can 2024; 46:102435. [PMID: 38458270 DOI: 10.1016/j.jogc.2024.102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient's multifibroid uterus created from their magnetic resonance imaging. METHODS 3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models. RESULTS Two staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference. CONCLUSIONS Patient-specific 3D anatomical models may be a useful tool to increase a surgeon's understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.
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Affiliation(s)
- Teresa E Flaxman
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON
| | - Carly M Cooke
- University of Ottawa, Faculty of Medicine, Department of Obstetrics and Gynecology, Ottawa, ON
| | - Olivier X Miguel
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON
| | - Adnan Sheikh
- University of British Columbia, Faculty of Medicine, Department of Radiology, Vancouver, BC
| | - Matthew McInnes
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON; The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON
| | - Shauna Duigenan
- University of Ottawa, Faculty of Medicine, Department of Radiology, Radiation Oncology and Medical Physics, Ottawa, ON; The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON
| | - Sukhbir Sony Singh
- Ottawa Hospital Research Institute, Department of Clinical Epidemiology, Ottawa, ON; University of Ottawa, Faculty of Medicine, Department of Obstetrics and Gynecology, Ottawa, ON; The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, ON.
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Won S, Kim K, Lee KH, Kim TJ, Kim T, Hwang JH, Park H, Kim MK, Hong DG, Song YJ, Seong SJ. Myomectomy with ArtiSential fully articulating laparoscopic instruments: A prospective multicenter study. Int J Gynaecol Obstet 2024. [PMID: 38358261 DOI: 10.1002/ijgo.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°-unrestricted movement of the wrist joint, as in robotic surgery. OBJECTIVE The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. METHODS A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. RESULTS The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2 ; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. CONCLUSIONS Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy.
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Affiliation(s)
- Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taehun Kim
- Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Hyun Park
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, CHA Bundang Medical Center, CHA University, Seoul, Republic of Korea
| | - Min Kyu Kim
- Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University of Medicine, Changwon, Republic of Korea
| | - Dae Gy Hong
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
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Kuru O, Erkan IBO, Bicer E. The concern about the educational quality of online videos on laparoscopic myomectomy. Rev Assoc Med Bras (1992) 2023; 69:e20230736. [PMID: 37971128 PMCID: PMC10645182 DOI: 10.1590/1806-9282.20230736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/26/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the surgical content of the 50 most-viewed laparoscopic myomectomy videos on YouTube while evaluating the educational quality and accuracy of the videos. METHODS In this cross-sectional study, the keyword "laparoscopic myomectomy" was searched in publicly available content on YouTube, and the videos were sorted by view count using YouTube's advanced search options. Out of the first 66 videos, only 50 were eligible according to our selection criteria. One associate professor of gynecology and one gynecology resident watched these videos independently and evaluated the quality and surgical aspects. Our primary outcome was the scores of the Quality Criteria for Consumer Health Information and Global Quality Score and the features of the surgical technique. RESULTS The 50 most-viewed laparoscopic myomectomy videos were uploaded between 2010 and 2021. They had a mean of 66636.6±103772.2 views. According to the Quality Criteria for Consumer Health Information criteria, 78% of the videos were categorized as "poor," 12% of them were "fair," and 10% of them were "very poor." The indication of the surgery was not specified in 27 (54%) of them. The surgeons in 39 (79.6%) of the videos did not use any containment system for the power morcellation, even though it was restricted by the United States Food and Drug Administration. The preoperative and perioperative precautions to minimize blood loss were underemphasized. There was no scientific evidence in 49 (98%) of the videos. CONCLUSION Laparoscopic myomectomy videos on YouTube are limited in terms of providing evidence-based and well-organized scientific knowledge.
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Affiliation(s)
- Oguzhan Kuru
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology – İstanbul, Turkey
| | - Ipek Betul Ozcivit Erkan
- Istanbul University-Cerrahpaşa, Cerrahpasa Faculty of Medicine, Department of Obstetrics and Gynecology – İstanbul, Turkey
| | - Elifnur Bicer
- Erbaa State Hospital, Department of Obstetrics and Gynecology – Tokat, Turkey
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Balulescu L, Nistor S, Lungeanu D, Brasoveanu S, Pirtea M, Secosan C, Grigoras D, Caprariu R, Pasquini A, Pirtea L. Minimizing blood loss in laparoscopic myomectomy with temporary occlusion of the hypogastric artery. Front Med (Lausanne) 2023; 10:1216455. [PMID: 37675138 PMCID: PMC10477596 DOI: 10.3389/fmed.2023.1216455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Uterine leiomyomas are common benign pelvic tumors. Currently, laparoscopic myomectomy (LM) is the preferred treatment option for women in the fertile age group with symptomatic myomas. The authors hypothesize that combining LM with a bilateral temporary occlusion of the hypogastric artery (TOHA) using vascular clips minimizes uterine blood flow during surgery and can significantly reduce surgery-associated blood loss. Materials and methods This single-center, prospective randomized study was conducted at the Department of Obstetrics and Gynecology, Municipal Emergency Clinical Hospital Timisoara, Romania. Patients aged between 18 and 49 who preferred laparoscopic myomectomy and wished to preserve fertility were included, provided they had intramural uterine leiomyomas larger than 4 cm in diameter that deformed the uterine cavity. The study analyzed data from 60 laparoscopic myomectomies performed by a single surgeon between January 2018 and December 2020. Patients were randomly assigned to either: "LM + TOHA" group (29 patients), and "LM" group (31 patients). The study's main objective was to evaluate the impact of TOHA on perioperative blood loss, expressed as mean differences in Hb (delta Hb). Results Delta Hb was statistically lower in the "LM + TOHA" group compared to "LM" group, with mean ± standard (min-max): 1.68 ± 0.67 (0.39-3.99) vs. 2.63 ± 1.06 (0.83-4.92) g/dL, respectively (p < 0.001). There was a statistically significant higher need for postoperative iron perfusion in the "LM" group, specifically 0 vs. 12 patients (p < 0.001), and lower postoperative anemia in "LM + TOHA" group (p < 0.001). Necessary artery clipping time was 10.62 ± 2.47 (7-15) minutes, with no significant impact on overall operative time: 110.2 ± 13.65 vs. 106.3 ± 16.48 (p = 0.21). There was no difference in the length of hospitalization or 12-month post-intervention fertility. Discussion Performing bilateral TOHA prior to laparoscopic myomectomy has proven to be a valuable technique in reducing surgery-associated blood loss, while minimizing complications during surgery, with no significant increase in the overall operative time. Clinical trial registration ISRCTN registry, (www.isrctn.com), identifier ISRCTN66897343.
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Affiliation(s)
- Ligia Balulescu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Samuel Nistor
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Diseases, Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Simona Brasoveanu
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Marilena Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Cristina Secosan
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Dorin Grigoras
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Radu Caprariu
- Department of Radiology and Medical Imaging, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Andrea Pasquini
- Center for Modeling Biological Systems and Data Analysis, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- “Pius Brinzeu” County Clinical Emergency Hospital, Timisoara, Romania
| | - Laurentiu Pirtea
- Department of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Department of Obstetrics and Gynecology, Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
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Ma S, Jeon GS, Kim KA, Kim HC, Kim YM, Lee C. Safety and effectiveness of uterine fibroid embolization in patients with scarred uterus. J Obstet Gynaecol Res 2023; 49:280-288. [PMID: 36251735 DOI: 10.1111/jog.15468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/23/2022] [Accepted: 10/04/2022] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the safety and effectiveness of uterine fibroid embolization (UFE) in patients with a scarred uterus caused by a previous myomectomy or cesarean section. METHODS A total of 140 patients who underwent embolization for symptomatic fibroids were included in this retrospective study. The patients were divided into two groups, those with a history of myomectomy and/or cesarean section (scarred uterus group, n = 56), and those without surgical history involving the uterus (no-scar group, n = 84). Demographics, embolization details, outcomes, and complications were analyzed. RESULTS The overall clinical success rate was 89.28% in the scarred uterus group and 95.24% in the no-scar group. There was no statistical difference in infarction rate or change in fibroid volume in follow-up magnetic resonance imaging between the groups. There was one major complication in the no-scar group, but there was no statistical difference in complications between the groups. The mean follow-up period was 25.9 months. The mean symptom-free time was 27.2 months in the scarred uterus group and 21.9 months in the no-scar group without a significant difference. There were no statistically significant differences in symptom changes, recurrence, and complication rates between the groups. Recurrence seen on imaging or regrowth was more common in the group with myomectomy history. However, there was no significant difference in symptom recurrence rates. CONCLUSION No statistically significant difference in technical and clinical outcomes was observed between the two groups. There was no significant increase in complication rates of UFE in scarred uterus group.
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Affiliation(s)
- Saebyol Ma
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Gyeong Sik Jeon
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Ah Kim
- Department of Radiology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyeon Chul Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong Min Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chan Lee
- Comprehensive Gynecologic Cancer Center, CHA Bundang Medical Center, CHA University, College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Won S, Choi SH, Lee N, Shim SH, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ. Effects of Using Barbed Suture in Myomectomy on Adhesion Formation and Adverse Pregnancy Outcome. J Pers Med 2022; 13. [PMID: 36675753 DOI: 10.3390/jpm13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/27/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Background: There is still concern regarding postoperative adhesion formation and adverse effects on pregnancy outcomes caused by barbed suture (BS) after myomectomy. The aim of this study was to compare the postoperative adhesion and pregnancy outcomes between conventional suture (CS) and BS after minimally invasive myomectomy (MIM) by robotic myomectomy (RM) or laparoscopic myomectomy (LM). Methods: The medical records of 94 women who had undergone MIM with CS and 97 who had undergone MIM with BS and achieved pregnancy were reviewed. Postoperative adhesion was evaluated following cesarean section. Results: The number of removed myomas was greater (5.3 ± 4.6 vs. 3.5 ± 3.1, p = 0.001) and the size of the largest myoma was larger (7.0 ± 2.2 vs. 5.8 ± 2.7 cm, p = 0.001) in the BS group relative to the CS group. A total of 98.9% of patients in the CS group and 45.4% in the BS group had undergone LM (p < 0.001), while the others underwent RM. There was no significant difference in the presence of postoperative adhesion at cesarean section between the BS and CS groups (45.5 vs. 43.7%, p = 0.095). Additionally, there were no intergroup differences in pregnancy complications such as preterm labor, placenta previa, accrete or abruption. Note also that in our logistic regression analysis, the suture type (BS or CS) was excluded from the independent risk factors regarding postoperative adhesion formation. Conclusions: Our data indicated that the incidence of postoperative adhesion after MIM with BS was similar when compared with CS. Also it seems that the suture type does not have a significant effect on pregnancy outcomes.
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Choi SH, Won S, Lee N, Shim SH, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ. Coaxial-Robotic Single-Site Myomectomy: Surgical Outcomes Compared with Robotic Single-Site Myomectomy by Propensity Score Matching Analysis. J Pers Med 2022; 13. [PMID: 36675678 DOI: 10.3390/jpm13010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/13/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The aim of this study was to introduce a coaxial-robotic single-site myomectomy (C-RSSM) technique to compensate for the shortcomings of robotic single-site myomectomy (RSSM) using semi-rigid instruments and to compare the surgical outcomes of C-RSSM and RSSM. METHODS The medical records of 13 consecutive women who had undergone C-RSSM and 131 consecutive women who had undergone RSSM were retrospectively reviewed. Patient characteristics and surgical outcomes after propensity score matching were evaluated and compared between the two groups. RESULTS According to the propensity score matching results, the C-RSSM group had a lower estimated blood loss (75.0 vs. 210.5 mL, p = 0.001) and a shorter operating time (101.0 vs. 146.1 min, p = 0.008) relative to the RSSM group. In RSSM, there was one case of conversion to conventional laparoscopy and four cases of conversion to the multi-site robotic approach. There was no case of conversion from C-RSSM to conventional laparoscopy or the multi-site robotic approach. CONCLUSIONS C-RSSM was found to be associated with shorter operative time and lower estimated blood loss. However, further prospective studies are needed to confirm these advantages.
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Zhao C, Lu ST, Wang Y, Hu P, Yan L, Liu MB, Liu LB, Lei L. Hysteroscopic management of a "hernia-like" uterine myoma within the uterine cavity. Fertil Steril 2022; 118:1199-1200. [PMID: 36307291 DOI: 10.1016/j.fertnstert.2022.08.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy. DESIGN Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient. SETTING Hospital. PATIENT(S) A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%). INTERVENTION(S) Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity. MAIN OUTCOME MEASURE(S) The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared. RESULT(S) The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section. CONCLUSION(S) A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma.
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Affiliation(s)
- Chengzhi Zhao
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Shen-Tao Lu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Pan Hu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Li Yan
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Ming-Bo Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Lu-Bin Liu
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China
| | - Li Lei
- Department of Obstetrics and Gynecology, Women and Children's Hospital of Chongqing Medical University, Longshan Road 120, Yubei District, Chongqing, People's Republic of China.
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10
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Antunes D, Gante I, Carvalho MJ, Medeiros-Borges C, Águas F. The impact of anemia on treatment management and clinical outcomes of women hospitalized for uterine leiomyomas. Ginekol Pol 2022; 93:799-805. [PMID: 36196563 DOI: 10.5603/gp.a2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/21/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Uterine leiomyomas are the most common benign gynecological tumors. Symptomatic leiomyomas represent a major cause of hospitalization, particularly those associated with abnormal uterine bleeding (AUB) and anemia. The aim of this study was to identify predictors of anemia in women hospitalized due to uterine leiomyomas and evaluate its impact on treatment management and clinical outcomes. MATERIAL AND METHODS Population-based retrospective study of women hospitalized for uterine fibroids in public hospitals in mainland Portugal between 2010 and 2015. Data were extracted from the national database of the Central Administration of the Portuguese Health System. Comparative and multivariable logistic regression analysis was performed to assess outcomes. RESULTS A total of 36 295 patients were hospitalized due to uterine leiomyomas during this period. Of those, 11.5% presented with anemia. Age, obesity, intramural type of leiomyoma and AUB are independent predictors of anemia (p < 0.001, AUC 0.7056). Anemia was associated with a high risk of inpatient hospitalization (OR: 5.161, 95% CI: 4.376-6.085), urgent admission (OR: 1.953, 95% CI: 1.797-2.121), radical surgical approach (OR: 2.559, 95% CI: 2.298-2.849), laparoscopic hysterectomy (OR: 1.575, 95% CI: 1.393-1.780) and intra- and post-operative complications (OR: 5.285, 95% CI: 4.332-6.448). It was also associated with longer hospital stays (p < 0.001). These outcomes were more pronounced in acute anemic patients. CONCLUSIONS Anemia has a significant impact on treatment approaches and clinical outcomes of women hospitalized for uterine leiomyomas. Age, obesity, intramural leiomyomas and AUB are some predictors of anemia that could represent a risk-stratification opportunity, allowing for its prompt identification and correction, therefore improving patient care.
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Affiliation(s)
- Dora Antunes
- Department of Gynecology, Coimbra Hospital and University Centre, Coimbra, Portugal. .,Faculty of Medicine, University of Coimbra, Portugal.
| | - Inês Gante
- Department of Gynecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,University Clinic of Gynecology, Faculty of Medicine, University of Coimbra, Portugal
| | - Maria João Carvalho
- Department of Gynecology, Coimbra Hospital and University Centre, Coimbra, Portugal.,University Clinic of Gynecology, Faculty of Medicine, University of Coimbra, Portugal.,Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Portugal.,Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal.,Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal
| | - Cláudia Medeiros-Borges
- Central Administration of the Portuguese Health System - Administração Central do Sistema de Saúde (ACSS), Lisbon, Portugal
| | - Fernanda Águas
- Department of Gynecology, Coimbra Hospital and University Centre, Coimbra, Portugal
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11
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Won S, Choi SH, Lee N, Shim SH, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ. Robotic Single-Site Plus Two-Port Myomectomy versus Conventional Robotic Multi-Port Myomectomy: A Propensity Score Matching Analysis. J Pers Med 2022; 12:jpm12060928. [PMID: 35743713 PMCID: PMC9225652 DOI: 10.3390/jpm12060928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Robotic single-site plus two port myomectomy (RSTM) was designed to reduce the number of incision sites while retaining the advantage of conventional robotic multi-port myomectomy (CRM). This study aimed to explicate RSTM and compare surgical outcomes between it and CRM. Methods: The medical records of 146 patients who had undergone RSTM and 173 who had undergone CRM were reviewed. The surgical outcomes between them were compared by propensity score matching (PSM) analysis. Results: The PSM analysis showed no statistically significant inter-group differences in patient characteristics. With regard to surgical outcomes, the RSTM group enjoyed shorter operative time (148.30 ± 44.8 vs. 162.3 ± 47.4 min, p = 0.011), less hemoglobin decrement (1.8 ± 0.9 vs. 2.3 ± 1.0 g/dL, p < 0.001), and shorter duration of hospital stay (5.4 ± 0.7 vs. 5.8 ± 0.7 days, p < 0.001). Conclusions: RSTM was associated with shorter operative time relative to CRM. Further prospective studies are needed in order to more fully investigate the advantages of RSTM.
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Affiliation(s)
- Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Su Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - So Hyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang 10414, Korea;
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul 06135, Korea; (S.W.); (S.H.C.); (N.L.); (S.H.S.); (M.K.K.); (M.-L.K.); (Y.W.J.)
- Correspondence:
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12
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Huang PH, Tsai MC, Ting WH, Chen HH, Lin HH, Hsiao SM. Predictors of surgical outcomes of laparoscopic myomectomy with barbed sutures: Comparison of V-Loc and Quill barbed sutures. Int J Gynaecol Obstet 2022; 158:757-759. [PMID: 35598148 DOI: 10.1002/ijgo.14276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Peng-Hsuan Huang
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Meng-Chieh Tsai
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Wan-Hua Ting
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Industrial Management, Asia Eastern University of Science and Technology, New Taipei, Taiwan
| | - Hui-Hua Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ho-Hsiung Lin
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan
| | - Sheng-Mou Hsiao
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Obstetrics and Gynecology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan
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13
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Rouholamin S, Hashemi M, Haghshenas S. The Effect of Vasopressin during Hysteroscopic Myomectomy in Patients with Submucosal Myoma: A Randomized Controlled Trial. Adv Biomed Res 2021; 10:22. [PMID: 34703801 PMCID: PMC8495297 DOI: 10.4103/abr.abr_70_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022] Open
Abstract
Background: The aim was to assess the effect of vasopressin in reducing the time of surgery, amount of bleeding, and fluid deficit during hysteroscopic myomectomy of submucosal myoma from 2016 to 2018. Materials and methods: This study was conducted as a prospective, randomized, single-blinded clinical trial on the premenopausal women ranged from 18 to 62 years' old. A number of 80 patients were randomly assigned to each arm of the study according to random consecutive numbers. The control group (n = 40) of patients underwent conventional hysteroscopic myomectomy without vasopressin and the case group (n = 40) underwent hysteroscopic myomectomy with the injection of diluted vasopressin. Measured outcomes were time for myomectomy, fluid deficit, inflow volume, visual clarity, and postoperation hemoglobin level. Results: The mean time of myomectomy was 38.1 and 77.38 min in vasopressin and control groups, respectively (P < 0.001). The mean inflow volume was 2800 and 4100 in vasopressin and control groups, respectively (P = 0.029). The visual clarity score was 8.5 and 6.5 in the vasopressin and control groups, respectively (P < 0.001). Conclusions: The injection of vasopressin during hysteroscopic myomectomy is effective in the management of fluid deficit, time of surgery, and improvement of visual clarity.
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Affiliation(s)
- Safoura Rouholamin
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Haghshenas
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Wahdan AS, Mohamed MM, Helmy NY, Shehata GH, Salama AK. Effects of Low-Dose Ketamine Infusion on Alleviating the Opioid Burden for Patients Undergoing Myomectomy Surgery. Turk J Anaesthesiol Reanim 2020; 49:52-57. [PMID: 33718906 PMCID: PMC7932722 DOI: 10.5152/tjar.2020.787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022] Open
Abstract
Objective Recent research has focused on the use of N-methyl-D-aspartate (NMDA) receptor antagonists for pain management. Several drugs are known to have this action, including ketamine, which exerts its main analgesic effect through NMDA receptor antagonism. This study aimed to evaluate the effect of low-dose ketamine infusion on opioid exposure for patients undergoing myomectomy surgery under general anaesthesia. Methods A total of 70 women were included in this prospective double-blind trial study. The patients included in this study were American Society of Anaesthesiologists physical status I-II, aged between 18 and 50 years and scheduled for laparotomy myomectomy surgery. Patients were randomised to receive either a bolus of 0.2 mg kg-1 of ketamine followed by a continuous infusion of 0.2 mg kg-1 hr-1 during the operation or a placebo of normal saline. Both groups also received morphine as needed for pain relief. The primary outcome was the total amount of morphine used during the intraoperative and postoperative periods. Intraoperative and postoperative mean blood pressure, heart rate and postoperative visual analogue scale for pain were assessed. Results Total mean morphine consumption was significantly lower in the ketamine group than in the control group (26±3.5 mg vs. 34.7±3.3 mg, respectively, p<0.05). However, there were no statistical differences between the groups regarding haemodynamics, postoperative pain score and complications. Conclusion The use of ketamine in low infusion doses intraoperatively during an elective myomectomy procedure produced an opioid-sparing effect by reducing perioperative morphine consumption without significant side effects.
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Affiliation(s)
- Amr Samir Wahdan
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mennattah Magdi Mohamed
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nadia Youssef Helmy
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehan Helmy Shehata
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Atef Kamal Salama
- Department of Anaesthesia, Surgical ICU and Pain Management, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Osorio W, Posada N, Cano J, Tamayo S, Giraldo J. Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula. Fertil Steril 2020; 115:522-524. [PMID: 33272627 DOI: 10.1016/j.fertnstert.2020.09.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To introduce a new double-lumen intracervical cannula designed to allow a single-step hysteroscopic myomectomy with nonfragmented complete fibroid extraction after cold enucleation of submucosal type 2 fibroids, avoiding complications related to the use of energy and hypo-osmolar solutions. DESIGN Video article depicting the use of a new double-lumen intracervical cannula for single-step hysteroscopic cold myomectomy, according to our institutional care guidelines and after obtaining the patient's informed consent. (The publication of this video has been authorized by the Institutional Ethics Committee of CES University in Medellín, Colombia.) SETTING(S): Private infertility clinic. PATIENT(S) A 45-year-old woman with abnormal uterine bleeding consisting of polymenorrhea and hypermenorrhea, nonresponsive to medical treatment, caused by three type 2 (FIGO leiomyoma subclassification system) submucosal fibroids of 17, 15, and 13 mm with more than 80% of intramyometrial component. INTERVENTION(S) Hysteroscopic enucleation of three submucosal fibroids performed by blunt dissection using the 30° Bettocchi hysteroscope's bevel under continuous observation of the avascular subcapsular plane of the fibroids. Once full enucleation was attained, cervical dilatation to 12 mm with Hegar plugs was performed followed by intracervical placement of a newly designed double-lumen intracervical cannula that allows the concomitant introduction of the Bettocchi diagnostic hysteroscope and a 5-mm laparoscopic tenaculum into the uterine cavity for complete nonfragmented fibroid extraction under direct visualization. MAIN OUTCOME MEASURE(S) Complete and unfragmented fibroid extraction in a single intervention, absence of surgical complications, and postoperative course. RESULT(S) Ambulatory hysteroscopic myomectomy of three submucosal type 2 fibroids was successfully performed by blunt enucleation and complete nonfragmented fibroid extraction using the double-lumen intracervical cannula. The total operative time was 32 minutes, and the total amount of distension media (normal saline) used was 800 mL with a liquid balance of 50 mL. No surgical or anesthesia-related complications occurred. In the postsurgical evaluation, the patient classified her pain as minimal, giving it a score of 1 on a pain scale of 1 to 5 (in which 1 is the lowest and 5 the highest pain perception). When asked about the level of satisfaction with the surgical procedure, the patient reported the highest degree of satisfaction with a score of 5 on a satisfaction scale of 1 to 5 (in which 1 is the lowest and 5 the highest satisfaction). The patient reported having postsurgical regular menstrual cycles every 28 days and 3 bleeding days without hypermenorrhea. CONCLUSION(S) An efficient hysteroscopic myomectomy of submucosal type 2 fibroids with deep intramyometrial component can be performed with complete and nonfragmented fibroid extraction in a single intervention by using a newly designed double-lumen intracervical cannula. This technique allows the completion of the surgery without the need of a resectoscope, electrosurgery, or hypo-osmolar uterine distension media, thus avoiding potential complications such as thermal-induced myometrial injury and hyponatremia; a second surgical intervention will not be required because the fibroid enucleation is complete. The procedure can be performed with the use of a diagnostic hysteroscope that is widely available in gynecologic practices. (Acknowledgment: The authors thank Dr. David Olive for the invaluable help and guidance with this surgical technique and video article.).
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Affiliation(s)
- Walter Osorio
- InSer, Instituto de Fertilidad Humana, Medellín, Colombia
| | - Natalia Posada
- InSer, Instituto de Fertilidad Humana, Medellín, Colombia
| | - John Cano
- InSer, Instituto de Fertilidad Humana, Medellín, Colombia
| | - Sergio Tamayo
- InSer, Instituto de Fertilidad Humana, Medellín, Colombia
| | - Juan Giraldo
- InSer, Instituto de Fertilidad Humana, Medellín, Colombia.
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16
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Lee SR, Lee ES, Lee YJ, Lee SW, Park JY, Kim DY, Kim SH, Kim YM, Suh DS, Kim YT. Robot-Assisted Laparoscopic Myomectomy versus Abdominal Myomectomy for Large Myomas Sized over 10 cm or Weighing 250 g. Yonsei Med J 2020; 61:1054-1059. [PMID: 33251780 PMCID: PMC7700878 DOI: 10.3349/ymj.2020.61.12.1054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Here, we compared the operative and perioperative outcomes between robot-assisted laparoscopic myomectomy (RALM) and abdominal myomectomy (AM) in patients with large (>10 cm) or heavy myomas (>250 g). MATERIALS AND METHODS We included 278 patients who underwent multi-port RALM (n=126) or AM (n=151) for large or heavy myomas in a tertiary care hospital between April 2019 and June 2020. The t-test, chi-square, Bonferroni's test, and multiple linear regression were used. RESULTS No differences were observed in age, body mass index, parity, or history of pelvic surgery between the two groups. Myoma diameters were not different (10.8±2.52 cm vs. 11.2±3.0 cm, p=0.233), but myomas were lighter in the RALM group than in the AM group (444.6±283.14 g vs. 604.68±368.35 g, respectively, p=0.001). The RALM group had a higher proportion of subserosal myomas, fewer myomas, fewer large myomas over >3 cm, lighter myomas, and longer total operating time. However, the RALM group also had shorter hospital stay and fewer short-term complications. Estimated blood loss (EBL) was not different between the two groups. The number of removed myomas was the most significant factor (coefficient=10.89, p<0.0001) affecting the EBL. CONCLUSION RALM is a feasible myomectomy technique even for large or heavy myomas. RALM patients tend to have shorter hospital stays and fewer postoperative fevers within 48 hours. However, RALM has longer total operating time.
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Affiliation(s)
- Sa Ra Lee
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Eun Sil Lee
- Department of Obstetrics & Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young Jae Lee
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Wha Lee
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Yeol Park
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Yeon Kim
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Man Kim
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Shik Suh
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Tak Kim
- Department of Obstetrics & Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Vasopressin local infiltration is useful in gynecological surgery because it can reduce
hemorrhage. Depending on the activities of the sympathetic system and the
renin–angiotensin system, reactions to vasopressin may differ and predicting its systemic
effects is difficult. Because life-threatening complications can occur, infiltration with
vasopressin should be administered with caution. A 42-year-old female patient was
diagnosed with uterine leiomyomas. During a robot-assisted laparoscopic myomectomy, 50 U
of vasopressin, which is ten-times the recommended dose, was accidentally infiltrated.
Subsequently, bradycardia with a heart rate of 25 bpm occurred, which recovered within 3
minutes. Peripheral perfusion indices and the diameter of the radial and brachial arteries
also decreased markedly and recovered within 1 hour. The surgery was concluded without
additional events. The patient was discharged 2 days later with no abnormal findings.
Because vasopressin infiltration can cause life-threatening complications, it is necessary
to determine the extent of patient reactions to vasopressin using measures such as the
peripheral perfusion index or radial and brachial artery diameters. These measures may
also help to predict the occurrence of complications.
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Affiliation(s)
- Jae Won Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Goo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Tae Woo Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Woong Han
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Mo Se Kim
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Chang Young Jeong
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Dong Ho Park
- Department of Anesthesiology and Pain Medicine, Daejoen Eulji Medical Center, Eulji University, Daejeon, Korea
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Kai K, Aoyagi Y, Nishida M, Arakane M, Kawano Y, Narahara H. Port-site implantation of parasitic leiomyoma after laparoscopic myomectomy and its histopathology. SAGE Open Med Case Rep 2020; 8:2050313X20959223. [PMID: 32995003 PMCID: PMC7502794 DOI: 10.1177/2050313x20959223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Although parasitic leiomyoma could be spontaneous or iatrogenic in origin, port-site implantation of parasitic leiomyoma is an iatrogenic benign sequela of laparoscopic surgery. A 30-year-old, primigravida Japanese woman was referred after unresponsiveness to preoperative gonadotropin-releasing hormone for intramural fibroids. Magnetic resonance imaging showed multiple intramural fibroids and left ovarian endometrioma with no malignant features. Laparoscopic myomectomy with power morcellation and ovarian cystectomy were performed, followed by treatment with a combined oral contraceptive. Seven years after the primary surgery, she underwent abdominal myomectomy for a port-site, and peritoneal recurrence of the leiomyoma and intramural leiomyomas was detected. Microscopic examination revealed that resected specimens from the port-site demonstrated leiomyoma with lesser cell density and more prominent hyalinization than those from the uterus. Therefore, clinicians should counsel patients regarding the risks and benefits of laparoscopy with morcellation versus laparotomy. Further development of techniques for uterine tissues extraction is warranted.
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Affiliation(s)
- Kentaro Kai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoko Aoyagi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Masakazu Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Motoki Arakane
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yasushi Kawano
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
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Hampson S, Rajaee AN, Steele D, Yudin MH. Spontaneous Intestinal Perforation in Pregnancy from a Pre-Existing Postoperative Adhesion: A Case Report. J Obstet Gynaecol Can 2020; 43:365-367. [PMID: 33051169 DOI: 10.1016/j.jogc.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spontaneous intestinal perforation is rare in pregnancy. Previously described cases have been associated with endometriosis, Crohn's disease, and intestinal tuberculosis. CASE We describe a case of spontaneous intestinal perforation in pregnancy from a postoperative adhesion. The patient presented with multiple episodes of abdominal pain and vomiting starting at 255 weeks. The diagnosis was made at 28 weeks when she presented with severe pain and abnormal fetal heart rate requiring emergency cesarean section with bowel resection. CONCLUSION This case demonstrates that adhesions between the bowel and uterus from prior surgery may lead to spontaneous intestinal perforation as the uterus enlarges during pregnancy. As this diagnosis can be difficult because of imaging limitations and physiologic changes of pregnancy, it should be considered in cases of unremitting abdominal pain and vomiting.
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Affiliation(s)
- Sarah Hampson
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON.
| | - Azadeh N Rajaee
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON
| | - Donna Steele
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON
| | - Mark H Yudin
- University of Toronto, Toronto, ON; St. Michael's Hospital, Toronto, ON
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20
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Won S, Lee N, Kim M, Kim MK, Kim ML, Jung YW, Yun BS, Seong SJ. Robotic single-site myomectomy: A hybrid technique reducing operative time and blood loss. Int J Med Robot 2019; 16:e2061. [PMID: 31840384 DOI: 10.1002/rcs.2061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/28/2019] [Accepted: 11/26/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND To introduce a hybrid robotic single-site myomectomy (H-RSSM) technique that includes laparoscopic single-site myoma excision followed by robotic single-site suture and compare its surgical outcomes with those of conventional robotic single-site myomectomy (RSSM) using the da Vinci Si surgical system. METHODS Medical records of 89 consecutive women who underwent H-RSSM and 131 consecutive women who underwent RSSM were retrospectively reviewed. Patients characteristics and surgical outcomes were evaluated and compared between two groups. RESULTS The H-RSSM group had a significantly reduced operation time (98.7 ± 31.7 vs 141.4 ± 54.4 min, P < .001) and lower estimated blood loss (131.5 ± 78.1 vs 212.3 ± 189.8 mL, P < .001). Peritoneal adhesions were reported significantly more in the H-RSSM group than in the RSSM group (27.0% vs 9.2%, P < .001). CONCLUSION H-RSSM was found to be associated with reduced operative time and lower estimated blood loss. However, further prospective studies are needed to clarify these advantages.
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Affiliation(s)
- Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
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21
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Abstract
Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disease
characterized by tumors derived from smooth muscles throughout the abdominal
cavity. DPL has been reported following laparoscopic myomectomy or hysterectomy;
however, few reports have described DPL after abdominal myomectomy or
hysterectomy. In the present case, two intra-abdominal masses were incidentally
discovered on imaging during a routine medical checkup of a 45-year-old woman
who had undergone laparoscopic uterine myomectomy 10 years previously. The
masses were later found to be near the ascending colon and between the liver and
right kidney. A malignancy or stromal tumor was suspected, and the patient
underwent exploratory surgery. Histopathologic examination revealed that the
masses were leiomyomas. Considering the patient’s history of gynecologic
surgery, we believe that this was a rare case of DPL following laparoscopic
uterine myomectomy.
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Affiliation(s)
| | - Ruopeng Zhang
- Peking Union Medical College Hospital, Beijing, China.,Peking Union Medical College, Beijing, China
| | - Yue Teng
- Peking Union Medical College Hospital, Beijing, China.,Peking Union Medical College, Beijing, China
| | - Beizhan Liu
- Peking Union Medical College Hospital, Beijing, China
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Ishiguro T, Yamawaki K, Chihara M, Nishikawa N, Enomoto T. Myomectomy scar ectopic pregnancy following a cryopreserved embryo transfer. Reprod Med Biol 2018; 17:509-513. [PMID: 30377408 PMCID: PMC6194266 DOI: 10.1002/rmb2.12212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/21/2018] [Indexed: 12/18/2022] Open
Abstract
CASE A 40 year old woman with a history of a myomectomy visited the Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan, following 2 years of infertility. Magnetic resonance imaging detected an abnormal endometrial-like pseudo-cavity. A hysterosalpingography also revealed an abnormal accumulation of contrast medium at the myometrial scar site. A transvaginal ultrasound showed a thin myometrium at the lower uterine body. The patient conceived via in vitro fertilization under a luteal phase down-regulation protocol (long protocol) for controlled ovarian stimulation, followed by a cryopreserved embryo transfer during her natural ovulation cycle. After the embryo transfer, the gestational sac was located at the subserosal site of the myomectomy scar. OUTCOME An emergent laparoscopic operation was performed and the embryo was removed successfully via laparoscopy under transvaginal ultrasonography. CONCLUSION A subserosal uterine pregnancy is a rare form of intramural pregnancy, which is a rare subtype of an ectopic pregnancy, which could occur at the myomectomy site, especially after an embryo transfer. It is believed that this rare ectopic pregnancy resulted from embryo implantation under the serosa through a micro-sinus tract that was a site of suture failure of the myomectomy scar and was partially affected by the embryo transfer. Clinicians should consider the possibility of an ectopic pregnancy after uterine surgery, including a myomectomy.
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Affiliation(s)
- Tatsuya Ishiguro
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Kaoru Yamawaki
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Makoto Chihara
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Nobumichi Nishikawa
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
| | - Takayuki Enomoto
- Department of Obstetrics and GynecologyNiigata University Medical and Dental HospitalNiigataJapan
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23
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Fonseca MCM, Castro R, Machado M, Conte T, Girao MJBC. Uterine Artery Embolization and Surgical Methods for the Treatment of Symptomatic Uterine Leiomyomas: A Systemic Review and Meta-analysis Followed by Indirect Treatment Comparison. Clin Ther 2017; 39:1438-1455.e2. [PMID: 28641997 DOI: 10.1016/j.clinthera.2017.05.346] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE There is significant discussion and uncertainty about the optimal management of symptomatic uterine leiomyomas (SULs). Nonsurgical procedures such as uterine artery embolization (UAE) have been developed. The goal of this study was to conduct a meta-analysis and an indirect treatment comparison to examine the comparative efficacy and safety of the surgical procedures to treat SULs compared with UAE. METHODS MEDLINE, EMBASE, Lilacs, and the Cochrane Central Register of Controlled Trials databases were searched from inception to February 2016. Ten randomized controlled trials comparing UAE versus hysterectomy, myomectomy, and laparoscopic occlusion of the uterine arteries in patients with SUL published in a peer-reviewed journal were included. Two reviewers independently selected studies, assessed quality, and extracted data. Discrepancies were resolved through consensus. FINDINGS Data from 986 patients submitted to UEA (n = 527) or surgery (n = 459) were analyzed. UAE had a lower risk of major complications (risk ratio [RR], 0.45 [95% CI, 0.22-0.95]; P = 0.04)and a higher risk of minor complications (RR, 1.65 [95% CI, 1.32-2.06]; P < 0.00001); UAE had a higher risk of re-intervention up to 2 years (RR, 3.74 [95% CI, 1.76-7.96]; P = 0.0006) and up to 5 years (RR, 5.01 [95% CI, 1.37-18.39]; P = 0.02); UAE had a similar risk of follicle-stimulating hormone levels >40 IU/L after 6 months (RR, 1.76 [95% CI, 0.24-12.95]; P = 0.58)and of recommending the procedure to another patient up to 5 years after treatment (RR, 1.00 [95% CI, 0.87-1.14]; P = 0.94). The indirect comparison between myomectomy and hysterectomy found that the 2 procedures were similar in the studied outcomes. IMPLICATIONS Compared with surgery, UAE had lower rates of major complications with an increased risk of re-intervention up to 2 and 5 years after the first procedure. UAE compared with surgery had a similar risk of ovarian failure and similar recommendation of the procedure to another patient. However, the number of trials was limited, and there was a high risk of bias in at least 2 domains. None of the trials blinded the participants and personnel or the outcome assessment. PROSPERO identifier: CRD42015026319.
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Affiliation(s)
- Marcelo C M Fonseca
- Department of Gynecology, Federal University of Sao Paulo, São Paulo, Brazil.
| | - Rodrigo Castro
- Department of Gynecology, Federal University of Sao Paulo, São Paulo, Brazil
| | | | - Tania Conte
- Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manoel J B C Girao
- Department of Gynecology, Federal University of Sao Paulo, São Paulo, Brazil
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24
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Temizkan O, Erenel H, Arici B, Asicioglu O. A case of parasitic myoma 4 years after laparoscopic myomectomy. J Minim Access Surg 2014; 10:202-3. [PMID: 25336821 PMCID: PMC4204264 DOI: 10.4103/0972-9941.141524] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 07/23/2014] [Indexed: 11/04/2022] Open
Abstract
We present a case of parasitic myoma complaining of abdominal pain, constipation, dyspareunia and dysmenorrhea 4 years after laparoscopic myomectomy. We performed laparoscopic myomectomy for multiple parasitic myomas. Three myomas were very firmly attached to bowel and mesentery. Parasitic myoma after laparoscopic surgery is very rare condition there are almost 35 cases in the literature. It is related with variable symptoms or can be asymptomatic. Laparoscopic surgeons should be aware of this situation, and further investigation should be made in case of suspicion. Surgery for parasitic myomas can be difficult in case of bowel and mesentery involvement and patient should be informed about the extensive surgery.
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Affiliation(s)
- Osman Temizkan
- Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hakan Erenel
- Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Bulent Arici
- Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Osman Asicioglu
- Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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25
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Abstract
BACKGROUND Fibroids are common benign tumours arising in the uterus. Myomectomy is the surgical treatment of choice for women with symptomatic fibroids who prefer or want uterine conservation. Myomectomy can be performed by conventional laparotomy, by mini-laparotomy or by minimal access techniques such as hysteroscopy and laparoscopy. OBJECTIVES To determine the benefits and harms of laparoscopic or hysteroscopic myomectomy compared with open myomectomy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (inception to July 2014), the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of Controlled Trials (inception to July 2014), MEDLINE(R) (inception to July 2014), EMBASE (inception to July 2014), PsycINFO (inception to July 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (inception to July 2014) to identify relevant randomised controlled trials (RCTs). We also searched trial registers and references from selected relevant trials and review articles. We applied no language restriction in these searches. SELECTION CRITERIA All published and unpublished randomised controlled trials comparing myomectomy via laparotomy, mini-laparotomy or laparoscopically assisted mini-laparotomy versus laparoscopy or hysteroscopy in premenopausal women with uterine fibroids diagnosed by clinical and ultrasound examination were included in the meta-analysis. DATA COLLECTION AND ANALYSIS We conducted study selection and extracted data in duplicate. Primary outcomes were postoperative pain, reported in six studies, and in-hospital adverse events, reported in eight studies. Secondary outcomes included length of hospital stay, reported in four studies, operating time, reported in eight studies and recurrence of fibroids, reported in three studies. Each of the other secondary outcomes-improvement in menstrual symptoms, change in quality of life, repeat myomectomy and hysterectomy at a later date-was reported in a single study. Odds ratios (ORs), mean differences (MDs) and 95% confidence intervals (CIs) were calculated and data combined using the fixed-effect model. The quality of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods. MAIN RESULTS We found 23 potentially relevant trials, of which nine were eligible for inclusion in this review. The nine trials included in our meta-analysis had a total of 808 women. The overall risk of bias of included studies was low, as most studies properly reported their methods.Postoperative pain: Postoperative pain was measured on a visual analogue scale (VAS), with zero meaning 'no pain at all' and 10 signifying 'pain as bad as it could be.' Postoperative pain was significantly less, as determined by subjectively assessed pain score at six hours (MD -2.40, 95% CI -2.88 to -1.92, one study, 148 women, moderate-quality evidence) and 48 hours postoperatively (MD -1.90, 95% CI -2.80 to -1.00, two studies, 80 women, I² = 0%, moderate-quality evidence) in the laparoscopic myomectomy group compared with the open myomectomy group. This means that among women undergoing laparoscopic myomectomy, mean pain score at six hours and 48 hours would be likely to range from about three points lower to one point lower on a VAS zero-to-10 scale. No significant difference in postoperative pain score was noted between the laparoscopic and open myomectomy groups at 24 hours (MD -0.29, 95% CI -0.7 to 0.12, four studies, 232 women, I² = 43%, moderate-quality evidence). The overall quality of these findings is moderate; therefore further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.In-hospital adverse events: No evidence suggested a difference in unscheduled return to theatre (OR 3.04, 95% CI 0.12 to 75.86, two studies, 188 women, I² = 0%, low-quality evidence) and laparoconversion (OR 1.11, 95% CI 0.44 to 2.83, eight studies, 756 women, I² = 53%, moderate-quality evidence) when open myomectomy was compared with laparoscopic myomectomy. Only one study including 148 women reported injury to pelvic organs (no events were described in other studies), and no significant difference was noted between laparoscopic myomectomy and laparoscopically assisted mini-laparotomy myomectomy (OR 3.04, 95% CI 0.12 to 75.86). Significantly lower risk of postoperative fever was observed in the laparoscopic myomectomy group compared with groups treated with all types of open myomectomy (OR 0.44, 95% CI 0.26 to 0.77, I² = 0%, six studies, 635 women). This indicates that among women undergoing laparoscopic myomectomy, the risk of postoperative fever is 50% lower than among those treated with open surgery. No studies reported immediate hysterectomy, uterine rupture, thromboembolism or mortality. Six studies including 549 women reported haemoglobin drop, but these studies were not pooled because of extreme heterogeneity (I² = 97%) and therefore could not be included in the analysis. AUTHORS' CONCLUSIONS Laparoscopic myomectomy is a procedure associated with less subjectively reported postoperative pain, lower postoperative fever and shorter hospital stay compared with all types of open myomectomy. No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy. More studies are needed to assess rates of uterine rupture, occurrence of thromboembolism, need for repeat myomectomy and hysterectomy at a later stage.
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Affiliation(s)
- Priya Bhave Chittawar
- Bansal HospitalDepartment of Reproductive MedicineC Sector ShahpuraBhopalMadhya PradeshIndia462016
| | - Sebastian Franik
- Radboud University NijmegenFaculty of Medical SchoolGeert Grooteplein 9PO Box 9101NijmegenNetherlands6500HB
| | - Annefloor W Pouwer
- Radboud University NijmegenFaculty of Medical SchoolGeert Grooteplein 9PO Box 9101NijmegenNetherlands6500HB
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
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26
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Weibel HS, Jarcevic R, Gagnon R, Tulandi T. Perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy. J Obstet Gynaecol Can 2014; 36:128-32. [PMID: 24518911 DOI: 10.1016/s1701-2163(15)30658-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Because of concerns about uterine rupture, many obstetricians recommend elective Caesarean section for women with a prior myomectomy. This practice has led to an increased rate of elective CS and subsequently of repeat Caesarean sections. The purpose of this study was to evaluate the perspectives of obstetricians on labour and delivery after abdominal or laparoscopic myomectomy. METHODS We conducted a survey of 49 practising obstetricians from July 2012 to January 2013, using a standard questionnaire. This included questions on labour and delivery after myomectomy by laparotomy or laparoscopy. RESULTS Overall, the inter-respondent agreement was fair (kappa 0.3; P < 0.001). There was no significant difference in the likelihood that respondents would allow vaginal delivery after myomectomy by laparotomy and by laparoscopy (27% and 14% if the uterine cavity was entered and 76% and 71% if the uterine cavity was not entered, respectively). However, the likelihood that respondents would allow vaginal delivery was significantly reduced if the uterine cavity was entered, regardless of the surgical approach (P < 0.001). Entry into the uterine cavity during myomectomy also significantly increased the likelihood that obstetricians would recommend elective CS rather than induction of labour. There was no significant difference in practice regarding the use of oxytocin with amniotomy, oxytocin infusion, or prostaglandins. CONCLUSION Despite a lack of evidence, obstetricians consider entry into the uterine cavity at myomectomy to be an important factor in determining the method of delivery, the use of oxytocin, and delivery by elective Caesarean section. This was independent of the myomectomy approach.
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Affiliation(s)
- Hélène S Weibel
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
| | - Radomir Jarcevic
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal QC
| | - Robert Gagnon
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
| | - Togas Tulandi
- Department of Obstetrics and Gynecology, McGill University, Montreal QC
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