Cases Of Myomectomy Research Articles

Myomectomy in the 14th week of pregnancy - case report

Uterine leiomyomas are the most common benign tumours in women. During the pregnancy, their prevalence is 2%. The management of leiomyomas in this period is eminently clinical, except in special situations. The decision by the indication of concomitant surgery pregnancy is complicated because in addition to the anaesthetic risks, studies show worse fetal prognosis. In this study, a rare case of myomectomy was reported in a 14-week gestation due to acute abdomen with intense pain. A 36-year-old primigravida was admitted to the Maternity emergency room, with severe abdominal pain, especially in the right hypochondrium and right flank, for 3 days. Ultrasonography showed leiomyoma measuring 15×11.4 cm. Exploratory laparotomy was performed with myomectomy. After surgery, pregnancy progressed normally until the 37th week, when the patient developed pre-eclampsia. At the opportunity, a caesarean section was performed. The new born was born healthy, weighing 3031g and Apgar 9 and 10. The decision to perform myomectomy is complicated and controversial. Its accomplishment is considered especially when all the other non-surgical therapies have failed, persisting or increasing pain. However, it should be considered the choice of surgery because of possible abdominal surgical complications in pregnancy.

Novel uterine closure technique to prevent intrauterine adhesions

The purpose of this video is to describe a novel uterine closure technique to prevent intrauterine adhesions after myomectomy. This is an important topic in the field as intrauterine adhesions can result in infertility, recurrent pregnancy loss, and future pregnancy complications, such as morbidly adherent placenta. In this video, we first discussed the epidemiology and the existing techniques that have been studied regarding the prevention of intrauterine adhesions. We then used an illustration to describe the suturing technique. We concluded with video clips demonstrating the technique from three of our myomectomy cases. This novel intraoperative uterine closure technique is one method that can potentially reduce the risk of intrauterine adhesion formation.

Association of operative time with outcomes in minimally invasive and abdominal myomectomy

To determine the association of operative time (ORT) with perioperative morbidity and whether there is an ORT at which minimally invasive myomectomy becomes inferior to laparotomy. Retrospective cohort study. Not applicable. Myomectomy cases identified by CPT code from 2005 to2016. Cases were stratified and analyzed by surgical approach and 90-minute intervals. Thirty-day postoperative morbidity. A total of 11,709 myomectomies were identified; 4,673 (39.9%) were minimally invasive, 6,997 (59.8%) were abdominal, and 39 (0.3%) were conversions. The incidence of complications significantly increased with ORT. After adjusting for confounders, mean ORT in minutes (95% confidence interval) was 113 (111-115) for abdominal, 156 (153-159) for minimally invasive, and 172 (148-200) for conversions. Despite shorter ORT, morbidity was greater in abdominal cases (16% vs. 5.7%), with the highest rates in converted cases (20.5%). The minimally invasive approach in general had lower odds of complications (odds ratio, 0.23; 95% confidence interval, 0.19-0.26). However, when minimally invasive surgery ORT reached ≥ 270minutes, the odds of a composite complication variable increased compared with abdominal cases <90minutes (odds ratio, 2.30; 95% confidence interval, 1.69-3.13). Of minimally invasive cases, 88% were completed in <270minutes. ORT was predictive of complications for both minimally invasive and abdominal myomectomies. Despite longer ORTs, minimally invasive procedures generally had superior 30-day outcomes up to 270minutes. Careful patient counseling and preparation to increase surgical efficiency should be prioritized for either approach.

A Case of Myomectomy with Temporomandibular Arthroplasty and Resection Case for 10 Years after Facial Multiple Fracture Injury

A Case of Myomectomy with Temporomandibular Arthroplasty and Resection Case for 10 Years after Facial Multiple Fracture Injury

Laparoscopic versus Abdominal Myomectomy: Surgical and Post-Operative Outcomes in CHRACERH-Yaounde

Introduction: Fibroid benign tumour of the uterus can be operated either by laparotomy or laparoscopy. Laparoscopy is not well vulgarised in our settings. Objective: The main objective was to compare the surgical and post-operative outcomes of laparoscopic versus abdominal myomectomy. Methods: We performed a comparative analytical cross sectional study from 1st January 2016 to 31st March 2018 consisted of two groups: group 1 of women who underwent laparoscopic myomectomy (LM) and group 2 of women who underwent abdominal myomectomy (AM). The data collected was entered in Epi Info 7.2 version and exported to IBM SPSS Statistics version 22 for analysis. We used alpha error margin of 5% and confidence interval of 95%. Results: We enrolled 50 cases of myomectomy consisted of 33 (66.0%) files for AM and 17 (34.0%) files for LM. The clinical presentation of fibroid was similar in both groups. The main operation time (H) was (1.27 ± 0.13) for laparoscopy which is much less than (2.05 ± 0.07) for laparotomy group (p = 0.006). In AM group we had 04 post-operatory complications against zero complications in LM group but the difference was not statistically significant (p = 0.387). In the second look laparoscopy, the types of adhesions were not statistically significant (p = 0.471). Conclusion: Laparoscopic offers advantages compared to abdominal myomectomy.

Contribution of the Tourniquet in the Prevention of Haemorrhages during Myomectomies at the University Hospital of Brazzaville

Objective: To check the effectiveness of tourniquet in the prevention of haemorrhage during myomectomies at the University Hospital of Brazzaville. Patients and methods: Analytical cross-sectional study, conducted at the University Hospital of Brazzaville from June 1, 2014 to June 30, 2016. Recruitment was performed by randomly matching each case of myomectomy performed using a tourniquet with two cases of myomectomy without tourniquet (50 cases vs 100 witnesses). We used as a tourniquet, the surgical glove knotted and tightened sufficiently at the level of the isthmus of the uterus to temporarily occlude the uterine arteries to ensure haemostasis lasting no more than one hour. Results: The mean age of the patients was similar in both groups (36, 1 ± 2.2 years vs 36.2 ± 1.9 years, P > 0.05). Menorrhagia was the most common indication of myomectomy in both groups (76% vs. 78% P > 0.05). The mean haemoglobin level of the patients before the myomectomies was 9.03 ± 1.10 g/dl vs 9, 75 ± 1.29 g/dl; P > 0.05. Intraoperative uterine features were similar in size (18 weeks gestation, 14 - 24) and number of myomas (5 vs 4, P > 0.05) in both groups. Polymyomectomy was more common in both groups (76% vs 73%, P > 0.05). Blood loss was reduced in the tourniquet group (90.5 ± 4.6 ml vs 200.4 ± 5.6 ml; P 0.05), as well as the use of blood transfusion (8% vs 50%, P 0.05). Use of the number of sutures was reduced in the group with tourniquet (3 ± 0.2 vs 6 ± 0.2 P 0.05). The duration of the procedure was shorter in the group with tourniquet (51.5 ± 4 min vs 83 ± 7 min, P 0.05). Postoperative mean haemoglobin of patients was no different between the two groups (9.4 ± 0.7 g/dl vs 9.2 ± 0.5, P > 0.05). The overall cost of management was reduced in the group with tourniquet (190,680 ± 1450 F CFA vs 256,800 ± 2350 FCFA; P 0.05). Conclusion: The use of tourniquet during myomectomies significantly reduces blood loss and the use of blood transfusion. We also obtain the notorious reduction in the use of sutures, the duration of interventions, and the overall cost of care. Thus, we encourage the systematic use of tourniquet during myomectomies by laparotomy.

Myomectomies of 65 Fibroids with Preservation of Uterus in a Nulligravida with Minimally Invasive Incision - A Rare Case with Review of Literature

Uterine fibroids are benign neoplastic growth arising from the myometrium, with estimated incidence being 20 - 40%. They are a major cause of morbidity in women of reproductive age group. The gold standard diagnostic modality for uterine fibroids appears to be gray - scale ultraso nography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medi cally, surgically, and even by minimal access techniques. Here we are reporting a case of myo mectomy with removal of 65 fibroids and conserving the uterus for future fertility.

The role of laparoscopic myomectomy in the modern management of uterine fibroids – a literature review

Uterine fibroids are the most common benign tumors of the genital female tract and the leading indication for hysterectomies in the USA. The prevalence rates quoted in literature range from 20-50%, based on postmortem studies. The prevalence varies with age, with an increase in the late reproductive period. Since the beginning of 1990s laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from literature, the authors report on the situation today regarding the operative technique for LM and the risks and benefits of the technique as compared with myomectomy by laparotomy. The operative technique include four main stage: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. A consensus gradually emerges that the maximal size of myoma must be 8-10 cm and the total number of fibroids should not exceed four. When conducted by experienced surgeons, the risk of perioperative complications is no higher using this technique. The use of laparoscopic approach could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of postoperative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. Some studies showed that the risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy. Laparoscopic myomectomy cases may become difficult if bleeding problems occur. Extended operative times may be necessary for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non condition of a modern surgeon.

Robotic-assisted single incision myomectomy in large myoma cases

Laparo-endoscopic single-incision surgery (LESS) has been developed and gradually adopted for both benign and malignant gynecological procedures. However, LESS has been hindered for use in procedures like myomectomy by limitations in natural architecture and instrumentation, especially in suturing. The da Vinci system features a single-site platform and wristed needle driver, which may help overcome conventional LESS limitations. This case report study describes the feasibility of this robotic single-site (RSS) platform in large myoma cases and offers suggestions. Two cases of myomectomy with large myomas (with maximum diameters of 160 and 120 mm) with different locations, were addressed by RSS. Operative time was 180 and 240 minutes. Estimated blood loss was 200 and 150 ml. Pathologic analysis revealed uterine leiomyomas of 910 and 870 grams. No serious peri- or post-operative complications occurred. Myomectomy with large myoma has presented a surgical challenge. RSS myomectomy appears to be a safe and feasible technique for it regardless of its localization. Advantages include less postoperative pain, fast recovery, less impact on quality of life, and improved cosmesis. LESS surgery has been challenging concerning suturing and multi-laparoscopic or multi-port robotic myomectomy can be difficult to extract myoma, especially with morcellation. RSS could be a solution that enables ease of manipflation and extraction.

Myomectomy Revisited: Experiences in a Teaching Hospital

Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital. A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016. Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours. Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status.

Nationwide population-based cohort study of uterine rupture in Belgium: results from the Belgian Obstetric Surveillance System

ObjectivesWe aimed to assess the prevalence of uterine rupture in Belgium and to evaluate risk factors, management and outcomes for mother and child.DesignNationwide population-based prospective cohort study.SettingEmergency obstetric care. Participation...

Laparoscopic Infections in Urogenital and Gynecological System: A Systematic Review

There are several advantages of laparoscopic surgery, which is employed only in the presence of some indications, as follows: minimally invasive procedure, reduced postoperative pain and analgesic use, and short hospital stay. In this paper we examined infections of laparoscopic operations by scanning MEDLINE and PubMed. A total of forty-seven papers were examined using a meta-analytical framework. In studies including a large series in adrenalectomy, the infectious complication rate, including various infections such as pneumonia, urinary tract infection, sepsis, and wound infection, is observed to be less than 1%. While infection is generally not developed during laparoscopy in nephrectomy patients, it may occasionally be seen, generally in the form of wound infection. The infectious complication rate associated with laparoscopic cystectomy was found to be high, which was attributed to surgical inexperience, presence of chronic diseases, and a lack of adequate equipment in hospitals. Complications of infection of prostactomy were not observed after procedures. The infection rate of hysterectomy is low; abscess and urinary tract infection are the most common infectious complications. Myomectomy cases generally showed no infection. Finally, it is associated with a lower wound infection rate and a reduced degree of abdominal damage and incisional hernia due to less scarring.

Randomized Comparison of Uterine Artery Embolization (UAE) with Surgical Treatment in Patients with Symptomatic Uterine Fibroids (REST Trial): Subanalysis of 5-Year MRI Findings

To report 5-year contrast-enhanced magnetic resonance imaging findings of the REST trial recruits who underwent either uterine artery embolization (UAE) or myomectomy. A total of 157 patients were randomized to UAE or surgery (hysterectomy or myomectomy). Ninety-nine patients who had UAE and eight patients who had myomectomy were analyzed. MRI scans at baseline, 6 months, and 5 years were independently interpreted by two radiologists. Dominant fibroid diameter, uterine volume, total fibroid infarction (complete 100 %, almost complete 90-99 %, partial <90 %), and new fibroid formation were the main parameters assessed and related to the need for reintervention. In the UAE group, mean ± standard deviation uterine volume was 670 ± 503, 422 ± 353, and 292 ± 287 mL at baseline, 6 months, and 5 years, respectively. Mean dominant fibroid diameter was 7.6 ± 3.0, 5.8 ± 2.9, and 5 ± 2.9 cm at baseline, 6 months, and 5 years. Fibroid infarction at 6 months was complete in 35 % of women, almost complete in 29 %, and partial in 36 %. Need for reintervention was 19, 10, and 33 % in these groups, respectively (p = 0.123). No myomectomy cases had further intervention. At 5 years, the prevalence of new fibroid was 60 % in the myomectomy group and 7 % in the UAE group (p = 0.008). There is a further significant reduction in both uterine volume and dominant fibroid diameter between 6 months and 5 years after UAE. Complete fibroid infarction does not translate into total freedom from a subsequent reintervention. New fibroid formation is significantly higher after myomectomy.

The role of laparoscopic myomectomy in the management of uterine fibroids

Laparoscopic myomectomy has been described as comparable to open myomectomy in terms of fertility and obstetrical outcome with decreased intraoperative bleeding and postoperative disability. Despite this, laparoscopic myomectomy is not widely used reportedly due to lack of experience. This article presents our technique for laparoscopic myomectomy and assesses the current evidence-based literature for the use of this minimally invasive procedure in benign gynecological practice. Literature continues to support the safety and feasibility of laparoscopic myomectomy for symptomatic women desiring to preserve their fertility. Alternatively, laparoscopically assisted myomectomy has been suggested when wider access is needed to perform the procedure. This variant of the technique allows palpating the uterus and does not require laparoscopic suturing skills. Robotic-assisted laparoscopic myomectomy currently has limited advantage over conventional laparoscopy due to longer operative time, loss of tactile sensation necessary to detect intramural myomas and high cost. Single-port surgery is a new promising approach, but still requires extensive investigation to determine whether it has significant benefits over conventional techniques. Laparoscopic myomectomy cases are mostly doable, but may become difficult if bleeding problems occur. Extended operative times may be required for morcellation and extensive laparoscopic suturing. Gynecologists need to improve their laparoscopic skills, as minimally invasive surgery is becoming the sine qua non of a modern surgeon.

The evaluation of myomectomies performed during cesarean section in our clinic

Background:We evaluated the data of patients who had applied myomectomy during cesarean section operation in our clinic between April, 2008 and December, 2010. Objective: I0 n this period, 3689 cesarean sections were done in our clinic, we analyzed their data retrospectively and determined 27 myomectomy cases during cesarean section operation. The age of the patients, the numbers of pregnancy, parities, the rates of abortus, indications of cesarean, pregnancy weeks, residential areas of myoms detected during the cesarean and their size, were recorded. Furthermore, pre-operative and post-operative hemoglobin (Hb) values, differences between hemoglobin values, whether there was bleeding or not, the need of blood transfusion if it occurred, the duration of operation and hospitaization and the pathological diagnoses of myomectomy materials, were examined.Materials and Methods:Retrospective study of myomectomies.Results:The mean age of patients was 29.6±5.9 (19-42) and mean gestational age was 39.2±1.0(37-42) weeks. The mean size of the fibroids was 5.94±6.29 cm3 (0.96-26.50 cm3). Subserous myoms were the most frequently seen ones (24 of 27 patients=89%) with fundal, corporal localizations in most of the instances. T0 he pre-operative and post-operative values of Hb were 11.8±1.52 (8.6-10.5) and 10.3±2.6 (6.9-13.3) g/dl respectively and the difference was statistically significant (P<0.001). Blood transfusion was not necessary in any patient. The mean duration of the operation was found to be 40.7±13.9 (13-60) minutes.Conclusion:Myomectomies can be performed safely during cesarean section by experienced obstetricians and gynecologists, and myomectomy performed for fibroids in appropriate localizations does not increase post-operative bleeding or maternal morbidity or mortality.

Cesarean section simultaneously Clinical summary of 330 cases of uterine fibroids

Objective To explore the analysis of pregnant women with uterine myoma during cesarean section uterine myomectomy at the Same time the safety and feasibility.Methods from March2003 to November 2008 hospital deliveries of 330 pregnant women with uterine fibmids at the same time cesarean section uterine myomectomy cases were retrospectively analyzed,with the same period 112cases of uterine fibroids in pregnancy simple cesqrean section compared to a comparative analysis of two groups of patients with operative time,intraoperative bleeding,puerperal morbidity,and postoperative recovery and so on.Results The cesarean section at the same time line of myomectomy during cesarean section,compared with the simple,simultaneous cesarean section line myomectomy operative time was significantly longer than cesarean section alone(P 0.05).Conclusion In patients choose the right circumstances,both cesarean section uterine myomectomy is feasible and safe,conducive to post-partum recovery,which can effectively avoid secondary surgery or hysterectomy,worthy to be popularized. Key words: Pregnancy; Complications; Cesarean section; Uterine myoma; Removed surgery

Two cases of myomectomy complicated by intravascular hemolysis and renal failure: disseminated intravascular coagulation or hemolytic uremic syndrome?

To present two cases of myomectomy complicated by intravascular hemolysis leading to acute renal failure and discuss the differential diagnosis and possible mechanism. Case report. Minimally Invasive Therapy Unit, University Department of Obstetrics and Gynecology. Two premenopausal patients with uterine fibroids. Both patients underwent otherwise uncomplicated myomectomies, one by laparotomy and one by laparoscopy, with tourniquets around the uterine and ovarian vessels being used to control intraoperative bleeding. Renal function in the postoperative period. Both patients developed a very rare complication after surgery of severe thrombocytopenia with microangiopathic hemolytic anemia leading to acute renal failure. One patient made a full recovery within weeks but the other still has reduced renal function almost 2 years after the surgery. The differential diagnosis consisted of disseminated intravascular coagulation or hemolytic uremic syndrome. The etiology of thrombotic microangiopathy in these patients was unclear, but disruption and manipulation of fibroids during surgery may have led to the dissemination of pro-coagulant tissue factor containing particles leading to disseminated intravascular coagulation or hemolytic uremic syndrome, perhaps aggravated by utero-ovarian ischemia caused by the tourniquets.

Myomectomy in early pregnancy—a case report

Uterine leiomyomas are by far the most common benign tumours of the female genital tract. The true incidence of leiomyomas during pregnancy is, however, unknown. Although leiomyomas usually remain asymptomatic during pregnancy, they may complicate its course. The management of leiomyoma during pregnancy is medical, but, in rare circumstances, surgical intervention and myomectomy may be required. A case of myomectomy in early pregnancy is described.

Unavoidable caesarean myomectomy: a case report

The standard practice is to avoid myomectomy during caesarean section. We present a case of myomectomy performed during caesarean section in a 32 year old primiparous woman. Uterine fibroid was diagnosed at 25 weeks gestation at the antenatal booking clinic. Patient was however symptom free throughout pregnancy. Elective caesarean section was undertaken at 38 weeks gestation on account of breech presentation and major placenta praevia. After delivery of the baby and placenta, the fibroid mass made uterine wound closure impossible, necessitating myomectomy. High dose oxytocin infusion was used to control intra-operative and post-operative haemorrhage. Outcome for mother and baby were satisfactory. Caesarean myomectomy can be safely undertaken in experienced hands whilst applying measures to reduce intra-operative and post-operative blood loss. Keywords: uterine fibroid, caesarean myomectomy, haemorrhage Tropical Journal of Obstetrics and Gynaecology Vol. 22(1) 2005: 81-82

Predictors of Leiomyoma Recurrence After Myomectomy

The purpose of this study was to evaluate the factors associated with the recurrence of leiomyomata after myomectomy. One hundred forty-five consecutive cases of myomectomy by laparotomy were studied retrospectively. Leiomyoma recurrence, diagnosed by transvaginal ultrasonography, was evaluated by life-table analysis and log-rank tests according to clinical characteristics of patients. The 5-year cumulative rates for leiomyoma recurrence and subsequent major surgery were 62% and 9%, respectively. At 5 years, the cumulative probability of recurrence was significantly lower in patients with a single leiomyoma removed (11%), compared with patients with multiple leiomyomata (74%) (P = .011); it was also lower in patients with intraoperative uterine size 10 menstrual weeks or less (46%), compared with more than 10 menstrual weeks (82%) (P = .032). However, there was a strong association of uterine size with the number of leiomyomata removed (P = .009). Childbirth after myomectomy was associated with a lower recurrence rate; the 5-year cumulative probability of recurrence was 26% in patients with subsequent parity, compared with 76% in those without subsequent parity (P = .010). Solitary myomectomy and smaller intraoperative uterine size are associated with lower rates of leiomyoma recurrence after myomectomy; the significance of uterine size may be affected by its correlation with the number of leiomyomata removed. Subsequent parity is associated with a lower probability of recurrence, but the cause and effect relationship between these two variables is unclear. II-3.