Cervical Myoma Research Articles

Cervical endometriosis: clinical character and management experience in a 27-year span

The purpose of this study was to analyze the clinicopathologic characters and explore the possible cause of cervical endometriosis. By retrospective review, among 13,566 cases of endometriosis that had been treated in our hospital, 33 cases of pathologically proven cervical endometriosis were extracted. Of 33 cases, 17 women had abnormal vaginal bleeding or visible cervical lesions; the other 16 women had no obvious clinical manifestations but were diagnosed retrospectively on histopathologic reports. Vaginal delivery or curettage procedures had occurred in 84.8% of patients. Only 2 patients had undergone cervical surgery of cryotherapy or electric excision. Seven cases were misdiagnosed before final surgery with the primary suspicion of cervical myoma, inflammatory cyst, cervical polyp, uterine submucous myoma, melanoma or melanin mole, and cervical cancer. Surgical treatment was performed for all symptomatic patients. No recurrence was seen. Cervical endometriosis should be distinguished from other benign or malignant cervical lesions. Surgical excision is suggested for symptomatic patients.

Temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy for cervical myoma

Objective To report our initial experience with temporary endovascular balloon occlusion of the bilateral internal iliac arteries to control hemorrhage during laparoscopic-assisted vaginal hysterectomy (LAVH) for cervical myoma. Study design Thirteen patients with cervical myoma were treated by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries from September 2008 to October 2010. Preoperative evaluation of cervical myoma was made by ultrasonography, magnetic resonance imaging and three-dimensional computerized tomographic angiography, and curative management was made by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. Results Nine patients with extracervical myoma and 4 patients with intracervical myoma were successfully managed by LAVH combined with temporary endovascular balloon occlusion of the bilateral internal iliac arteries. For extracervical myomas, the median extirpated uterine weight was 591 g (range 360–1010 g). Median duration required for placement of balloon occlusion catheter was 60 min (range 47–69 min). Median surgical duration was 98.5 min (range 77–149 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 66 min (range 42–98 min). The median estimated blood loss was 355 mL (range 50–1950 mL). For intracervical myomas, the median extirpated uterine weight was 513 g (range 302–710 g). Median duration required for placement of balloon occlusion catheter was 63 min (range 42–76 min). Median surgical duration was 96.5 min (range 92–100 min). Median duration of endovascular balloon occlusion of the bilateral internal iliac arteries was 49 min (range 44–60 min). The median estimated blood loss was 210 mL (range 150–650 mL). Transfusion of preoperatively donated autologous blood negated the need for bank blood. There were no major interventional radiological and surgical complications in the present case series. Conclusions Temporary endovascular balloon occlusion of the bilateral internal iliac arteries is a feasible minimally invasive alternative to control hemorrhage during LAVH for cervical myoma.

Handling cervical myomas

Compared to myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified, as the organs that have to be considered differ depending on the location of the myoma. Surgical difficulties associated with these cases are, poor access to the operative field, difficulty in suturing the repairs, increased blood loss, and distortion of the anatomy of the vital neighboring structures in the pelvic cavity.

Strategy for Laparoscopic Cervical Myomectomy

Cervical myomas are closer to other organs, and the approach needs to be modified since the organs. We divided cervical myomas into 2 types according to location, comprising an intracervical type and extracervical types. Subjects comprised 16 patients who were diagnosed with cervical myoma in our hospital, and who underwent laparoscopic myomectomy. Result: Mean operative time was 105.8±43.2min, mean blood loss was 105±117 ml, and mean specimen weight was 208.3±195.4g. Conclusions:16 cases of cervical myoma can be performed safely by developing a uniform strategy. if sufficient attention is paid to the following 6 points: 1) using of preoperative GnRH; 2) determining the positional relationship between the myoma and surrounding organs; 3) temporarily blocking uterine artery blood flow; 4)using of vasopressin; 5) positioning the incision in the myometrium somewhat lateral to the uterine corpus; and 6) the bottom of the wound should be pulled up by the forceps for suturing. Cervical myomas are closer to other organs, and the approach needs to be modified since the organs. We divided cervical myomas into 2 types according to location, comprising an intracervical type and extracervical types. Subjects comprised 16 patients who were diagnosed with cervical myoma in our hospital, and who underwent laparoscopic myomectomy. Result: Mean operative time was 105.8±43.2min, mean blood loss was 105±117 ml, and mean specimen weight was 208.3±195.4g. Conclusions:16 cases of cervical myoma can be performed safely by developing a uniform strategy. if sufficient attention is paid to the following 6 points: 1) using of preoperative GnRH; 2) determining the positional relationship between the myoma and surrounding organs; 3) temporarily blocking uterine artery blood flow; 4)using of vasopressin; 5) positioning the incision in the myometrium somewhat lateral to the uterine corpus; and 6) the bottom of the wound should be pulled up by the forceps for suturing.

Clinical Analysis of Laparoscopic Myomectomy for Patients with Cervical Myoma

Study Objective: To investigate the best treatment method and clinical efficacy of laparoscopic myomectomy for patients with cervical myoma.Design: Retrospective study.Setting: Department of Gynecology, Changzhou Second People's Hospital, Jiangsu, PR China.Patients: 120 patients enrolled for cervical myoma between June 2005 and June 2009.Intervention: Sixty patients underwent laparoscopic myomectomy and sixty patients underwent abdominal myomectomy.Measurements and Main Results: Compared to the patients in group of abdominal myomectomy, the patients in group of laparoscopy had less blood loss (102 mL vs 241 mL), shorter period of taking antibiliotics (5.6 d vs 7.1 d) and hospital stay (5.6 d vs 7.9 d) (P <0.001). However, there were no significant difference in myoma size and operation time between the two groups (P >0.05).Conclusion: The efficacy of laparoscopic myomectomy for patients with uterine cervical myoma is similar to abdominal myomectomy. Laparoscopic myomectomy has advantages of minimal invasion and quick recovery. Study Objective: To investigate the best treatment method and clinical efficacy of laparoscopic myomectomy for patients with cervical myoma. Design: Retrospective study. Setting: Department of Gynecology, Changzhou Second People's Hospital, Jiangsu, PR China. Patients: 120 patients enrolled for cervical myoma between June 2005 and June 2009. Intervention: Sixty patients underwent laparoscopic myomectomy and sixty patients underwent abdominal myomectomy. Measurements and Main Results: Compared to the patients in group of abdominal myomectomy, the patients in group of laparoscopy had less blood loss (102 mL vs 241 mL), shorter period of taking antibiliotics (5.6 d vs 7.1 d) and hospital stay (5.6 d vs 7.9 d) (P <0.001). However, there were no significant difference in myoma size and operation time between the two groups (P >0.05). Conclusion: The efficacy of laparoscopic myomectomy for patients with uterine cervical myoma is similar to abdominal myomectomy. Laparoscopic myomectomy has advantages of minimal invasion and quick recovery.

Total Laparoscopic Hysterectomy in a Patient with a Large Cervical Myoma

Total Laparoscopic Hysterectomy in a Patient with a Large Cervical Myoma

Cervical Myomectomy with Uterine Artery Ligation at Its Origin

Cervical myomas account for less than 5% of uterine myoma. We ligate the uterine arteries before myomectomy for large myomas to reduce the blood loss intraoperatively. We demonstrate cervical myomectomy with uterine artery ligation at its origin. We use a supraumbilical 10mm optical port and three 5 mm accessory ports. We dissect the triangle enclosed by the round ligament, external iliac vessels and infundibulopelvic ligament with harmonic ultracision. The areolar space is dissected and the origin of the uterine artery from the internal iliac is identified.

Strategy of cervical myomectomy under laparoscopy

To evaluate a strategy of laparoscopic excision of a cervical myoma (CM). Prospective study. University-affiliated hospital. Twenty-eight patients with CM underwent laparoscopic myomectomy. These cases were classified into five types according to the location: [1] anterior cervical myoma (ACM); [2] posterior cervical myoma (PCM); [3] central cervical myoma (CCM); [4] lateral cervical myoma [LCM]; and [5] deep-rooted cervical myoma (DCM). After preoperative assessment, patients underwent laparoscopic myomectomy. Ligation of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy. Myoma numbers, myoma weight, operative time, estimated blood loss, hospital stay, complication rate. Most of the lesions were ACM (43%) and PCM (32%). The mean operative time was 121 minutes, mean blood loss was 99 mL, and mean myoma weight was 287 g. The mean hospital stay was 2.2 days. There were no complications. Histopathologic examination showed that all lesions were leiomyoma. Hypermenorrhea, dysmenorrhea, and symptoms of compression improved after the operation. Two infertile patients conceived spontaneously at 1 and 7 months postoperatively, and successfully delivered infants by cesarean section at term. Surgical treatment of CM is empirically difficult. It is important that the approach be changed according to the location and size of the myoma.

Strategy for Laparoscopic Cervical Myomectomy

Objective Myoma of the uterine cervix is rare, accounting for about 5% of all myomas. Compared with myomas that occur in the uterine corpus, cervical myomas are closer to other organs such as the bladder, ureter, and rectum, and the approach needs to be modified because the organs that have to be considered differ depending on the location of the myoma. We divided cervical myomas into 2 types according to location, comprising an intracervical type and extracervical types. A clear outline of surgical treatment for cervical myoma has not described in previous papers. We then investigated the surgical strategy for these types. Patients Subjects comprised 16 patients who were diagnosed with cervical myoma in our hospital between January 2005 and April 2009, and who underwent laparoscopic myomectomy. Result Mean operative time was 105.8±43.2 (82.8-128.8) min, mean blood loss was 105±117 (42.6-167.4) ml, and mean specimen weight was 208.3±195.4 (99.3-306.2) g. Histopathological examination showed atypical myoma in 1 case and leiomyoma in others. Conclusions 16 cases of cervical myomectomy were performed safely by developing a uniform strategy that uses a fixed operative procedure, even with laparotomy, if sufficient attention is paid to the following 6 points: 1) attempting to reduce the size of the myoma with the use of preoperative GnRH; 2) determining the positional relationship between the myoma and surrounding organs; 3) temporarily blocking uterine artery blood flow with the use of vessel clips; 4) suppressing bleeding during myomectomy with the use of vasopressin; 5) minimizing the risk of damaging surrounding organs by positioning the incision in the myometrium somewhat lateral to the uterine corpus; and 6) the bottom of the wound after enculation should be pulled up by the forceps for suturing to avoid making dead space.

Strategy of Cervical Myoma under Laparoscopy

Strategy of Cervical Myoma under Laparoscopy

Robotic Resection of Cervical Myoma with Endocervical Tract Misconceived as Double Uterus

Robotic Resection of Cervical Myoma with Endocervical Tract Misconceived as Double Uterus

Cervical Myomectomy with Uterine Artery Ligation at Its Origin

This study was performed to examine the feasibility, blood loss, duration of surgery, and complications in patients with cervical myomas in whom the uterine artery was ligated before myomectomy. Laparoscopic cervical myomectomy was performed in 12 women with cervical myomas and menorrhagia. The uterine artery was ligated at its origin from the internal iliac as an initial step to reduce the blood loss. Myomectomy was subsequently performed, and the myomas were enucleated by incising the capsule anteriorly or posteriorly depending on their location. Hysterectomy was not necessary in any patient. Even large cervical myomas were removed with minimal blood loss. Laparoscopic cervical myomectomy is a minimally invasive and technically safe procedure.

Uterine C-Kit positive low grade stromal sarcoma

Uterine C-Kit positive stromal tumors are rare, however, there are a few cases reported in literature. A 58-year-old post menopausal lady presented with bleeding per vaginum. An abdominal examination revealed an enlarged uterus. A computed tomography scan of the abdomen and pelvis showed a large myomatous uterus, with a probable subserosal intramural and intracavitary myoma or cervical myoma in the presence of a solitary large aortocaval node, with multiple bone lesions. The biopsy taken from the uterine mass had revealed, a low-grade uterine sarcoma, which was positive for CD117. This case is presented for its rarity and management dilemma.

Cervical Myoma Experienced as Prolapse

Cervical Myoma Experienced as Prolapse

Temporary endovascular balloon occlusion of the bilateral internal iliac arteries for control of hemorrhage during laparoscopic-assisted myomectomy in a nulligravida with a large cervical myoma

To describe the preoperative evaluation and minimally invasive management of a large cervical myoma in a nulligravida who wished to preserve fertility. Case report. Departments of obstetrics and gynecology and radiology at a general hospital. A 33-year-old nulligravida with a large cervical myoma. A large cervical myoma was preoperatively diagnosed by ultrasonography, magnetic resonance imaging, and computed tomographic angiography and was successfully treated with minimal blood loss by laparoscopic-assisted myomectomy combined with prophylactic temporary endovascular balloon occlusion of the bilateral internal iliac arteries. Uterine conservation. Fertility preservation was achieved with minimal blood loss in a nulligravida with a large cervical myoma. Laparoscopic-assisted myomectomy combined with prophylactic endovascular balloon occlusion of the bilateral internal iliac artery was an effective minimally invasive procedure to preserve fertility in a nulligravida with a large cervical myoma.

Spontaneous Vaginal Expulsion of Huge Hypervascular Myoma Following Uterine Artery Embolization

Study Objective: Uuterine artery embolization(UAE) is being increasingly utilized to treat uterine fibroid. But, the effects on fertility preservation following UAE are still under investigation. We present a case of huge cervical myoma spontaneously removed by UAE.

Acute urinary retention due to huge cervical myoma with abdomino-vaginal extensions

Acute urinary retention due to huge cervical myoma with abdomino-vaginal extensions

Hysterectomy in treatment of cervical myoma: a comparison between abdominal and vaginal routes

目的 比较宫颈肌瘤全子宫切除术的经腹和经阴不同手术途径患者恢复情况,探讨两者的优缺点.方法 回顾性分析比较宫颈肌瘤患者经腹(n=30)、经阴(n=24)子宫全切术的手术时间、术中出血量、恢复肛门排气时间、术后住院天数.结果 手术时间经阴组明显少于经腹组(t=2.672,P＜0.05);术中出血量经阴组小于经腹组(t=3.214,P＜0.05);术后肠功能恢复经阴组快于经腹组(t=2.412.P＜0.05);术后住院天数经阴组明显短于经腹组(t=3.458,P＜0.05).结论 宫颈肌瘤阴式子宫切除患者住院时间明显少于经腹子宫切除组,术后并发症发生率低,是宫颈肌瘤患者子宫切除的较佳术式。

Urethrovaginal Fistula due to Prolapsed Cervical Myoma: A Case Report

The occurrence of cervical myoma is not common, but they merit special considerations in view of their proximity to important pelvic structures including ureters, their propensity to cause complications and the technical difficulty in their removal. Herein, we report the first case of urethro-vaginal fistula due to pressure effect of huge prolapsed cervical myoma.

A new enucleation method for cervical myoma via laparoscopy

Laparoscopic myomectomy was performed on five women suffering from hypermenorrhea. A new method was used which enucleated the cervical myoma from postcervical medial incision. The wound was sutured in 2 layers intracorporeally. Clipping of the uterine artery and injection of diluted vasopressin were performed to decrease bleeding during laparoscopy. This is a minimally invasive and safe procedure.