Cervical Myomectomy Research Articles

Tips and Tricks for Cervical Myomectomy

Tips and Tricks for Cervical Myomectomy

Inadvertent prolapse of a huge cervical fibroid mimicking acute uterine inversion: A case report

Prolapse of cervical fibroid is a rare but life threatening occurrence. This complication may occur early in some patients while in others it may follow complications like constipation, difficulty in micturition to mention a few. A 47 +o year old Para o lady presented to the Accident and Emergency Unit of our hospital with a two(2) day history of a huge mass protruding per vagina and a history of significant bleeding per vagina. Packed Cell Volume was 19% on admission and she had Four(4) units of blood transfused. She subsequently had examination under general anaesthesia and cervical myomectomy was done. Her Post Operative clinical state was satisfactory.

Uterine Conserving Cervical Myomectomy in a Young Nulliparous Woman in Navy Reference Hospital Calabar, Nigeria

Management of cervical fibroid which is one of the rare sites of uterine fibroid comes with challenges to gynaecologists especially in young nulliparous women where uterine conserving surgery is to be instituted. Cervical fibroid locations can be in the supravaginal or vaginal aspect of the cervix. It can also present as pedunculated fibroid or sessile fibroid from the cervical lip. The commonest presentations of cervical fibroid are pelvic pressure symptoms and menstrual irregularities. This is a case of a 24 year old nulliparous woman with recurrent pelvic pressure symptoms, heavy menstrual flow and vaginal discharge with diagnosis of cervical fibroid and vaginal fibroid polyp and was managed by uterine conserving surgery.

Cervical Fibroid Myomectomy

Study Objective This video reviews various techniques to reduce risk of blood loss and injury when performing a laparoscopic cervical myomectomy. Design N/A. Setting The techniques and surgery demonstrated in this video were performed on a patient who underwent laparoscopic cervical myomectomy in an academic tertiary care center. This patient had a large (8 × 8 cm) symptomatic cervical fibroid and desired future fertility, so she opted to have a myomectomy. The size and location of this fibroid increased the risk of blood loss and damage to the ureters or bladder. Various techniques were employed during surgery to reduce these risks, and the techniques shown in this video may be helpful in similar cases. Patients or Participants N/A. Interventions Three techniques were used in this video to reduce risk of blood loss and injury to nearby structures. First, the ureters and uterine artery are identified. Retroperitoneal dissection is performed and the ureter is isolated on its course beneath the uterine artery. Additionally, the obliterated umbilical artery is pulled which confirms the identification of the internal iliac artery and the uterine artery. By clearly identifying these structures, one can avoid injury during operation. Second, vascular clips are temporarily applied to the uterine arteries bilaterally. This reduces blood flow to the uterus while performing the myomectomy and afterwards the clips are removed once hemostasis is ensured. Third, vasopressin is injected below the uterine serosa to cause vasoconstriction and temporary reduction in blood flow while performing the myomectomy. Measurements and Main Results N/A. Conclusion Laparoscopic cervical myomectomy can be performed using various techniques to reduce the risk of bleeding and injury to nearby structures. This video reviews various techniques to reduce risk of blood loss and injury when performing a laparoscopic cervical myomectomy. N/A. The techniques and surgery demonstrated in this video were performed on a patient who underwent laparoscopic cervical myomectomy in an academic tertiary care center. This patient had a large (8 × 8 cm) symptomatic cervical fibroid and desired future fertility, so she opted to have a myomectomy. The size and location of this fibroid increased the risk of blood loss and damage to the ureters or bladder. Various techniques were employed during surgery to reduce these risks, and the techniques shown in this video may be helpful in similar cases. N/A. Three techniques were used in this video to reduce risk of blood loss and injury to nearby structures. First, the ureters and uterine artery are identified. Retroperitoneal dissection is performed and the ureter is isolated on its course beneath the uterine artery. Additionally, the obliterated umbilical artery is pulled which confirms the identification of the internal iliac artery and the uterine artery. By clearly identifying these structures, one can avoid injury during operation. Second, vascular clips are temporarily applied to the uterine arteries bilaterally. This reduces blood flow to the uterus while performing the myomectomy and afterwards the clips are removed once hemostasis is ensured. Third, vasopressin is injected below the uterine serosa to cause vasoconstriction and temporary reduction in blood flow while performing the myomectomy. N/A. Laparoscopic cervical myomectomy can be performed using various techniques to reduce the risk of bleeding and injury to nearby structures.

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

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

The Novel Application of Transvaginal Notes for Hysteroscopic Polypectomy and Cervicalmyomectomy

Study Objective To demonstrate the advantages of using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for both hysteroscopic polypectomy and cervical myomectomy. Design Video presentation of the surgical procedure. Setting University hospital. Patients or Participants A sexually inactive patient with numerous comorbidities presented with irregular vaginal bleeding in the setting of worsening pelvic pain and bladder pressure for three year. Pelvic MRI showed multiple cervical fibroids and an endometrial polyp. Interventions After the patient was anesthetized, a narrow vagina with no visibility of the cervical os was detected. vNOTES hysteroscopic polypectomy and cervical myomectomy were determined to be more appropriate than conventional methods. A GelPOINT mini port was first placed in the vagina, which allowed for entrance into the uterine cavity. A Myosure hysteroscope and laparoscopic tenaculum were inserted through the port, and polyps in the uterine cavity were then removed. After polypectomy, a transverse incision was made on the anterior cervix through the same port for cervical myomectomy. The tenaculum was used to grab the fibroid and a harmonic scalpel was then applied for enucleation. V-loc was used to close the incision and reconstruct the cervical canal. After suturing, hysteroscopy was performed again to confirm normal anatomy. A Foley catheter was placed to prevent cervical stenosis. Measurements and Main Results Complete resection of cervical myoma and uterine polyp were performed, with postoperative relief of symptoms (i.e. bladder pressure). The surgery was 70 mins with Conclusion For patients with cervical polyps and/or myomas who cannot be operated by conventional methods, NOTES hysteroscopy and myomectomy may be an attractive option and lead to less surgical complications, reduced pain, and faster recovery.

Laparoscopic Cervical Myomectomy with PRE-Operative Uterine Artery Embolization and Concomitant Abdominal Cerclage: A Case Report

Laparoscopic Cervical Myomectomy with PRE-Operative Uterine Artery Embolization and Concomitant Abdominal Cerclage: A Case Report

Cervical Reconstruction after Cervical Myomectomy or Hysterectomy: Operative Challenges in Huge Cervical Fibroids

Cervical Reconstruction after Cervical Myomectomy or Hysterectomy: Operative Challenges in Huge Cervical Fibroids

14: Cervical myomectomy: a minimally-invasive approach

To illustrate the use of robotic-assisted laparoscopy in the removal of a large cervical myoma. Uterine leiomyomas affect 70-80% of reproductive aged women and cervical myomas account for less than 5% of uterine myomas. Symptoms of cervical myomas include pelvic pain, bulk symptoms, dyspareunia, abnormal bleeding or discharge, and diminished fertility. Surgical removal of cervical myomas may be indicated to relieve symptoms and preserve fertility. Cervical myomectomies are challenging due to difficult surgical dissection through the cervical stroma as well as proximity to the cervical canal and other vital pelvic structures including bowel, bladder, uterine vessels, and ureter. In this video, we illustrate the key surgical steps of robotic-assisted laparoscopic cervical myomectomy and highlight some of the surgical challenges. Key surgical steps include:1.Identify pathology and key anatomy.2.Infiltrate myometrium with dilute vasopressin.3.Strategic hysterotomy.4.Identification and careful dissection of anatomic plans.5.Tenaculum for traction/countertraction.6.Closure.7.Manual and contained tissue extraction. A minimally invasive surgical approach is a feasible option in a patient with a markedly enlarged cervical myoma.

Tips and Tricks for Laparoscopic Cervical Myomectomy

Objective: To share techniques for performing laparoscopic cervical myomectomy.

Cervical Myomectomy

Cervical Myomectomy

Office hysteroscopic cervical myomectomy

IntroductionLeiomyomas are the most common tumors of the uterus andthe female pelvis, with an estimated prevalence of 40–50 %.The main symptom is transvaginal bleeding being responsi-ble for high levels of hysterectomy worldwide [1]. Othercomplaints are dyspareunia, abdominopelvic discomfort,and lower abdominal pain. They are benign tumors com-posed mainly of smooth muscle cellsassociated with fibrousconnective tissue in varying amounts. The clinical treatmentcan be accomplished with gestrinone, GnRH analogues, anddanazol in premenopausal women seeking improvement inbleeding until menopause. GnRH analogue may be a thera-peutic option for 3 to 6 months; when necessary for a longerperiod, it should be combined with gonadotropic hormonesto minimize the effects of bone demineralization.Thesurgicalapproach,myomectomy,isthedefinitivetreat-mentofdiseaseandmaybedonebylaparotomy,laparoscopy,or hysteroscopy, depending on the number, size, and locationof the nodules. In some cases, a hysterectomy may be indi-cated,particularlyinwomenwithnodesireoffuturepregnan-cy. Most fibroids are situated in the uterine body, with aminority (less than 5 %) in the cervical canal [2, 3]. Theapproach to the cervical myoma is complex, since it is closerto the ureters, bladder, rectum, and cervical vessels [3].Hysteroscopic myomectomy is a complex surgery indi-cated in cases of submucosal fibroids. The main complica-tions of the procedure are bleeding, uterine perforation, andoverload. The procedure can be done as office hysteroscopicmyomectomy using biopsy punch and scissors or bipolarelectrodes, or as hospital hysteroscopic myomectomy withcervical dilation using mono or bipolar resectoscope.In 2005, Lasmar et al. developed the STEPW classifica-tion [4, 5] which provides the degree of difficulty of hys-teroscopic myomectomy by classifying the fibroidspreoperatively. This classification includes intracavitary fib-roids only; cervical fibroids are not contemplated. Hystero-scopic myomectomy may be performed by differenttechniques: direct mobilization, slicing, or both [6, 7]. Itcan be used with U or L resectoscope handle, with orwithout energy, either monopolar or bipolar. In direct mobi-lization, the Collins electrode is used in shape of an “L” todissect the endometrium around the fibroid. The “cold elec-trode” is used to mobilize the fibroid in all directions, doingthe coagulation only of the vessels that are bleeding. Afterreleasing the nodule from the uterinewall, it can beremovedby grasping forceps. If the fibroid is too large, it can besliced in several pieces using the Collins electrode [6].Inofficehysteroscopicprocedure,weprefertousethedirectmobilization technique as well with biopsy punch, sectioningfibrousbeams of themyoma pseudocapsule as it is mobilized.Saline infusion is used as distension media. This technique issimilartothatinthehospitalsettingandallowstheresectionoffibroid very close to the uterine safely and efficiently [ 8, 9].Theliterature hasfewdata onthemanagement of cervicalmyomas, with most referrals regarding cervical myomec-tomy by laparoscopy route [3, 10]. The approach to cervicalfibroids by hysteroscopy is possible, mainly on those withlittle intramural component, and should be done cautiouslydue to the small wall thickness and short proximity toimportant structures of the pelvis [3]. The presence of largemasses leads to a dilatation of the cervical canal, difficultingits distension and making the procedure even harder.Case presentationA 46-year-old woman attended the gynecology ambulatoryof University Antonio Pedro Hospital, complaining of ab-normal uterine bleeding. Her gynecologic history was two

Approach to Cervical Myomectomy and Trachelectomy

We present an unusual case of a 40-year-old woman with pelvic pain and pressure. Patient had a history of a supracervical hysterectomy five years ago for fibroids. Imaging confirmed recurrence of a fibroid in the cervical stump. This video illustrates a laparoscopic approach to cervical myomectomy and trachelectomy, with special attention to the adhesiolysis and anterior dissection required to effectively perform the procedure.

Endometrial Cancer with Cervical Extension Mimicking Dual Concordant Endometrial and Cervical Malignancy by F-18 FDG PET and MRI

A 35-year-old woman with endometrial cancer and cervical extension underwent F-18 FDG PET-CT [1–6] and MRI studies after resection of a cervical mass presumed to be cervical myoma. The patient underwent cervical myomectomy and the histopathologic report revealed poorly differentiated invasive carcinoma. Cervical cancer was ruled out because the patient had no history of sexual intercourse and was negative for human papilloma virus infection. The patient underwent radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and multiple biopsies. F-18 FDG PET-CT (Fig. 1a–e) showed intense FDG uptake along the cervix wall. T2-weighted MRI (Fig. 1f, g) also revealed a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Another area of focal increased uptake above the endometrial lesion in the left pelvic cavity was observed on PET-CT and MRI, possibly due to a functioning ovary. PET-CT and MRI were interpreted as showing a dual concordant malignant lesion due to separated FDG uptakes and high SI without any connection between the cervical and endometrial lesions. Fig. 1 F-18 FDG PET-CT (a–e) shows intense FDG uptake along the cervix wall. T2-weighted MRI (f, g) reveals a mass lesion with high SI involving the anterior and posterior lips of the uterine cervix. Together, these images were interpreted as showing ... F-18 FDG PET-CT (Fig. 2a–e) showed intense FDG uptake along the endometrium. Given the patient’s history and the fact that she was not menstruating at the time of imaging, this intense uptake was interpreted as another pathologic lesion, suggesting dual primary lesions. A suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer was found on MRI (Fig. 2f, g). Endometrial cancer with cervical extension is sometimes difficult to differentiate from primary cervical cancer. Fig. 2 F-18 FDG PET-CT (a–e) shows intense FDG uptake along the endometrium. MRI (f, g) shows a suspected heterogeneous mass lesion along the endometrium suggesting concordant endometrial cancer The final histopathologic report showed poorly differentiated endometrial adenocarcinoma with cervical extension, although the FDG PET-CT and MRI findings were suggestive of concordant cervical and endometrial cancer. Although histopathologic confirmation is necessary for final diagnosis, MRI and FDG PET-CT studies may aid in the differential diagnosis. A metastatic cervical mass from endometrial cancer clinically presenting as cervical myoma is rare. This case suggests that poorly differentiated endometrial cancer may extend into the cervix, presenting as cervical myoma, and the possibility of a metastatic mass should be considered in the differential diagnosis when dealing with 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.

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.