Laparoscopic Myomectomy Research Articles

The impact of epigallocatechin gallate, vitamin D, and D-chiro-inositol on early surgical outcomes of laparoscopic myomectomy: a pilot study.

A prospective investigation to assess the impact of 3months of treatment with epigallocatechin gallate (EGCG), vitamin D and D-chiro-inositol (DCI) in the treatment of uterine fibroids (UF) with laparoscopic myomectomy as evidenced by surgical outcomes and effect on liver function. Non-pregnant or lactating women aged between 30 and 40years were scheduled for laparoscopic myomectomy to treat symptoms or looking to conceive. After enrollment, patients were assigned to either (1) intervention group, assuming a total of 300mg EGCG, 50μg vitamin D, and 50mg DCI divided in 2 pills per day for 3months, or (2) control group, including untreated women scheduled to undergo laparoscopic myomectomy after 3months. 91 patients completed the study. The comparison of the surgical outcomes between the intervention (n = 44) and the control (n = 47) groups revealed that the treatment significantly reduces the duration of surgery (41.93 ± 7.56min vs 56.32 ± 10.63min, p < 0.001). Moreover, the treatment also reduced blood loss during surgery (149.09 ± 25.40mL vs 168.41 ± 21.34mL, p < 0.001), resulting in treated patients having higher Hb levels at discharge 11.27 ± 0.82mL vs 10.56 ± 0.82mL, p < 0.01). The surgery induced an increase in AST and in total bilirubin regardless of the assigned group, and the treatment induced no change in liver function. Our data suggest that EGCG plus vitamin D, and DCI could represent a safe option for women with UF scheduled for laparoscopic myomectomy, improving surgical outcomes without affecting liver functionality.

Status and treatment of patients with uterine fibroids in hospitals in central China: a retrospective study from 2018 to 2021

ObjectiveTo evaluate the hospitalised patients with uterine fibroids (UFs) and describe treatment patterns in hospital-treated patients in central China from 2018 to 2021.DesignA retrospective analysis.SettingThe gynaecology departments of class A...

Disseminated Peritoneal Leiomyomatosis: An Unusual Complication of Laparoscopic Myomectomy

Disseminated Peritoneal Leiomyomatosis (DPL) is characterised by multiple smooth muscle tissues over the peritoneal surface of the pelvic and abdominal cavity. Possible causes of DPL include hormonal factors, subperitoneal mesenchymal stem cell metaplasia, genetic factors, or iatrogenic factors. Hereby, the authors represents a case of DPL in a 42-year-old female with a history of two Laparoscopic Myomectomies. She presented with complaints of abdominal distension and bilateral lower limb pain lasting eight months. She underwent a robotic hysterectomy with bilateral salpingectomy and the removal of intraperitoneal nodules. Intraoperative findings showed a mass resembling leiomyoma over the uterus, mesentery, spleen, and rectosigmoid. She was discharged on postoperative day 4 and has been asymptomatic for the past two years. Robotic surgery is an emerging surgical modality in the treatment of DPL due to its better precision and ease of accessibility to upper abdominal organs. More importantly, recovery time is enhanced, and it reduces the duration of hospital stay.

Application of transumbilical paring and retrieving techniques in laparoscopic myomectomy

Application of transumbilical paring and retrieving techniques in laparoscopic myomectomy

Uterine sarcoma post laparoscopic myomectomy using morcellation; systematic review

The Food and Drug Administration released a safety communication in 2014 advising physicians not to do laparoscopic power morcellation for myomectomy, hysterectomies, or the removal of uterine fibroids. The purpose of this study was to ascertain how morcellation affected the survival rates of patients with uterine sarcoma who had myomectomy or hysterectomy. The Web of Science, PubMed, Embase, and Scopus databases were searched for publications that had been published between the years 2003 and 2024. It aimed to find all original English-language studies comparing the outcomes between patients with uterine morcellation following laparoscopic myomectomy or hysterectomy and those without. A total of seven studies were included in this review. In most of the included studies, the group that underwent morcellation included patients undergoing laparoscopic, open abdominal, vaginal, and hysteroscopic surgery. In contrast, the group without morcellation consisted of all patients undergoing open abdominal surgery. Patients who had uterine morcellation were more likely to experience tumor metastases than those in the group without morcellation. The rate of reoperations was higher in patients who had morcellation than those who did not. Overall, five studies found that morcellation deteriorating outcomes, whereas the other two found no significant difference between morcellation and non-morcellation. The available evidence indicated that in patients with uterine sarcomas, morcellation increases the risk of intra-abdominal and total recurrences but not the risk of extra-abdominal recurrences. Nevertheless, a link was found between morcellation and reduced survival rates.

Impact of Ropivacaine with Dexmedetomidine in Enhancing Perioperative Outcomes in Laparoscopic Myomectomy

Impact of Ropivacaine with Dexmedetomidine in Enhancing Perioperative Outcomes in Laparoscopic Myomectomy

Comparison of Laparoscopic and Open Myomectomy in a Tertiary Hospital: A Retrospective Cohort Study

Comparison of Laparoscopic and Open Myomectomy in a Tertiary Hospital: A Retrospective Cohort Study

Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis.

To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017-2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids. Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA ($13,134 and $14,428) and highest for UAE ($28,214 and $19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were $2429 and $5939 for LAP-RFA, $2122 and $8368 for LM, $4410 and $11,942 for AM, and $8113 and $46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data. In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.

Anesthetic Management of a Patient With Hemoglobin M Disease Undergoing Laparoscopic Uterine Myomectomy: A Case Report

Hemoglobin M (Hb M) is a group of abnormal Hb variants that form methemoglobin, which leads to cyanosis. Patients with Hb M appear cyanotic but are usually asymptomatic. Cyanosis with low peripheral oxygen saturation is unresponsive to oxygen therapy despite normal partial pressure of oxygen. As such, close attention should be paid during anesthesia. We report the first case of a Hb M patient undergoing laparoscopic uterine myomectomy under general anesthesia.

Ultrasonographic Characters of Uterine Myoma as Predictors for Successful Laparoscopic Myomectomy at Mansoura University Hospital

Background: Myomectomy is the surgical procedure of choice for symptomatic myoma in the reproductive age, especially if future fertility is desired. LM is the surgical removal of uterine myoma through small incisions in the abdomen. It is an appropriate, if not preferred, alternative to abdominal myomectomy in well-selected patients since it offers shorter hospitalization, short recovery period and resumption of activities within 1–2 weeks, reduced risk of blood transfusion, and intraoperative adhesions. Aim: The aim of the current study was to determine the diagnostic accuracy of different ultrasonographic characters of uterine myoma in predicting success of laparoscopic myomectomy. Methods: The present study was prospective interventional study that was carried out on 35 cases with Chronic pelvic pain. All patients had radiological evaluation by TVS and TAS. All Laparoscopic myomectomies done under general anaesthesia. Outcomes included determining ultra-sonographic predictors for successful laparoscopic myomectomy as regards site, size, and character of Myoma, presence of capsule and line of separation around myoma. Results: The most common complain among the studied cases was bleeding followed by pain and lastly infertility. Regarding location, the most common site was posterior followed by fundal, then anterior and lastly at the cornu. Operative times, blood loss amount, method of extraction, need laparoscopic suturing, complications during surgery recovery and hospital stay after operation demonstrated significant relation with outcomes. Myoma characters, numbers and type demonstrated insignificant relation with outcomes. Conclusion: The current study concluded that, myoma characters, numbers and type could not be used as predictors for successful LM; outcomes. However, operative times, blood loss amount, complications during surgery recovery and hospital stay after operation were less in successful LM than in LAM; and laparoscopic suturing and morcellation have less time consumption and better results than LAM.

Myomectomy - Choosing the Surgical Approach

In patients who are desirous of future pregnancy and choose to preserve the uterus, myomectomy is the best surgical option where medical management is not suitable for the patient. Myomectomy was initially performed successfully in 1840 by Amussat and the procedure has evolved from open laparotomy to laparoscopy, hysteroscopy, VNOTES and robotic myomectomy. The surgical approach in doing myomectomy depends on the type and location of the myoma and the surgeon’s expertise. Minimally invasive surgery has been the preferred approach due to the benefit of shorter hospital stay, lesser postoperative pain, earlier recovery, minimal blood loss and the cosmetic appearance of the scar. The success of this procedure depends also on the incision technique, enucleation, blood loss prevention by employing hemostatic techniques as well as suturing techniques. Performing myomectomy for a large uterine myoma is a laparoscopic challenge; however, with the use of Lee-Huang point (midpoint between umbilicus and xiphoid) as the primary insertion and camera port, one can easily navigate thru the abdominal cavity in case the uterus is huge obscuring the umbilical port. Laparoscopic Myomectomy can be safely and efficiently performed by experienced laparoscopic surgeons regardless of myoma size, number, and location. Removal of large myoma specimen from the abdominal cavity through the laparoscope became a challenge after the use of power morcellator was abandoned. To overcome this problem, the large myoma is placed inside an Endo bag and its edges brought extracorporeally through the port site. The myoma is incised in a C-manner using a scalpel to reduce the size. Myoma can also be removed using in-bag morcellation. Fertility preservation is the long-term aim of doing myomectomy instead of hysterectomy in the management of leiomyoma aside from alleviating symptoms of abnormal uterine bleeding, urinary frequency, and abdominal pain. Thus, every procedure should perform under patient centered concept.

#133 : Hysteroscopy Guided Embryo Transfer, a Newer Approach for Difficult Embryo Transfer

Background: Embryo transfer (ET) is a crucial step in IVF process. Therefore, difficult ET can significantly impact the odds of implantation. We propose that hysteroscopy guided ET might be a feasible alternative to conventional ultrasound guided ET in such cases. Case Report: This is the case of a 27-year-old woman with six years of primary infertility with severe dysmenorrhoea and menorrhagia. TVS showed a bulky adenomyotic uterus with multiple fibroids primarily in the posterior wall distorting the endometrial cavity and bilateral huge endometriomas. She underwent laparoscopic adenomyomectomy, myomectomy and bilateral Tubo-ovarian mass removal. Subsequently, she underwent IVF with donor eggs after 5 months therapy with long-acting GnRH agonist. Mock ET was attempted but was unsuccessful due to acute anterior flexion of the cervix. So, she was planned for ET under general anaesthesia, but the ET catheter could not be negotiated through the internal os. A 30∘ 3 mm hysteroscope was then inserted through the cervical canal using saline as distension media. Additionally, a small polyp was noted at the internal os blocking the entry of ET catheter. Once the endocervical canal was distended the catheter was negotiated from the side of hysteroscope into the cervical canal and it passed through the internal os easily under direct vision of hysteroscope. The hysteroscope was then withdrawn holding the catheter at its place. Complete evacuation of saline from endometrial cavity was confirmed by trans abdominal USG and a double ET was done under USG guidance. The routine post ET medication protocol was followed. Her Serum [Formula: see text]-hCG result was positive and after an uneventful pregnancy, she delivered healthy twin babies at 35 weeks. Conclusion: The introduction of hysteroscopy guided ET may be a suitable alternative in cases of difficult ET.

Baseball Suture versus Traditional Suture in Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis

Baseball Suture versus Traditional Suture in Laparoscopic Myomectomy: A Systematic Review and Meta-Analysis

Risk of placenta accreta spectrum following myomectomy: a nationwide cohort study

BackgroundWhether myomectomy increases the risk of placenta accreta spectrum (PAS) in the following pregnancies remains controversial. ObjectiveThis study aimed to investigate the effect of myomectomy on the risk of placenta accreta spectrum in the following pregnancies. Different methods of myomectomy on the risk of placenta accreta spectrum were also explored. Study designA nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database including all pregnant patients in Taiwan who gave birth between January 2008 and December 2017. A 1:1 propensity-score estimation matching was performed for the analysis of myomectomy on the risk of placenta accreta spectrum. Among pregnant patients who received myomectomy, different methods of myomectomy on the risk of placenta accreta spectrum were compared with control group. ResultsAmong the 1,371,458 pregnant patients in this study, there were 11,255 pregnant patients who had history of myomectomy. The risk of PAS in pregnant patients with history of myomectomy was higher than pregnant patients without history of myomectomy (incidence 0.96% vs. 0.20%, adjusted odds ratio 2.28, 95% CI 1.85-2.81, p<0.01). Among pregnant patients with history of myomectomy, 5,045 (46.87%) pregnant patients received laparotomic myomectomy, 3,973 (36.93%) received laparoscopic myomectomy, and 1,742 (16.20%) received hysteroscopic myomectomy. The incidence of PAS in the hysteroscopic group was higher than that in the laparotomic group or the laparoscopic group (1.89%, 0.71%, and 0.81% respectively, p<0.05 vs. the hysteroscopic group). The adjusted odds ratio for PAS was 3.88 (95% CI 2.68-5.63) in the hysteroscopic group compared to subjects without history of myomectomy (p<0.05). ConclusionMyomectomy, especially hysteroscopic myomectomy, is associated with increased risk of PAS in the subsequent pregnancy.

In-bag extraction of tissue through an incision in the posterior vaginal wall in laparoscopic myomectomy: a large retrospective study

BackgroundOur purpose was to describe the outcomes of transvaginal in-bag tissue extraction tissue through an incision in the posterior vaginal wall the middle part incision of posterior vagina in laparoscopic myomectomy.MethodsThis was a retrospective study of patients who received laparoscopic myomectomy and in-bag tissue extraction through an incision in the posterior vaginal wall between January 2016 and December 2022. Patient characteristics, intra- and post-operative complications, and outcomes were collected and analyzed.ResultsA total of 511women were included in the analysis. The mean largest myoma diameter was 8.44 ± 3.56 cm; mean specimen weight was 789.23 ± 276.97 g; mean operative time was 129.01 ± 53.13minutes; and mean blood loss was 175.99 ± 210.96 mL. Within 30-days of surgery, no fever, infection, or vaginal bleeding was noted in any patient, and the vaginal incisions of all patients had healed well. There were no incisional hernias, pelvic infections, and vaginal adhesions noted at follow-up 3 months after the operation. There were 37 cases of vaginal delivery of the patients after surgery, and there were no lacerations of the posterior wall vaginal incision.ConclusionsTransvaginal in-bag extraction though an incision in the posterior vaginal wall is feasible and safe for removing tissue after laparoscopic myomectomy.

High-intensity Focused Ultrasound is a Better Choice for Women with Fertility Desire: A Systematic Review and Meta-analysis of the Comparison between High-intensity Focused Ultrasound and Laparoscopic Treatment of Uterine Fibroids.

High-intensity focused ultrasound (HIFU) is commonly used to treat uterine fibroids and adenomyosis, but there is no evidence using metadata to compare fertility outcomes between conventional laparoscopic procedures and HIFU. The purpose of this study analysis is that evidence-based fertility outcomes may provide better treatment options for clinicians and patients considering fertility. The literature on fertility data for HIFU surgery versus laparoscopic myomectomy was searched in seven English language databases from January 1, 2010, to November 23, 2022. A total of 1375 articles were received in the literature, 14 of which were selected. We found that women who underwent HIFU surgery had higher rates of spontaneous pregnancy, higher rates of spontaneous delivery, and higher rates of full-term delivery but may have higher rates of miscarriage or postpartum complications than women who underwent laparoscopic myomectomy. Looking forward to future studies, it is hoped that the literature will examine endometrial differences in women who undergo HIFU and laparoscopic myomectomy to demonstrate the ability of endometrial repair. The location of fibroids in the sample should also be counted to allow for attribution statistics on the cause of miscarriage.

Laparoscopic myomectomy is safe in patients with previous abdominal surgery

Aims: The excision of myomas is commonly carried out in symptomatic women who choose to preserve their uterus, either using an open or minimally invasive (hysteroscopy, laparoscopy, robotic) approach. Patient selection is a critical factor in achieving a successful laparoscopic myomectomy. Prior abdominal surgery was not defined as a risk factor, however, the safest approach in these cases is still the subject of intense debate The aim of this study was to evaluate the safety of laparoscopic myomectomy in patients with previous abdominal surgery.&#x0D; Methods: A retrospective cohort study was conducted on the files and operative notes of the patients who underwent laparoscopic myomectomy operation in a university-hospital based gynaecology department between January 2012 and March 2017. The patients were classified into two groups; Group 1 consisted of 34 patients who had previously undergone abdominal surgery, whereas the Group 2 comprised 118 patients who had not undergone any abdominal surgery.&#x0D; Results: There were no significant difference between patients with and without a history of abdominal surgery in terms of operation time, postoperative hospital stays, blood loss, rate of operative complications, or conversion rate to open surgery.&#x0D; Conclusion: A history of abdominal surgery seems to have no negative impact on the safety of a subsequent laparoscopic myomectomy.

Laparoscopic Myomectomy in a Patient with MRKH

Laparoscopic Myomectomy in a Patient with MRKH

9508 Characteristics Associated with Blood Transfusion Among Women Undergoing Laparoscopic Myomectomy; A NSQIP Study

9508 Characteristics Associated with Blood Transfusion Among Women Undergoing Laparoscopic Myomectomy; A NSQIP Study

Comparison of Postoperative Complications Between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy

To compare postoperative complications of laparoscopic myomectomy (LM) with total laparoscopic hysterectomy (TLH). A secondary outcome examined whether complications differ by age. A retrospective cohort study. A multicenter academic healthcare system. Individuals > 18 years old undergoing LMfrom 2011 to 2021 or TLH for benign indications from 2020 to 2021. LM or TLH. There were 1178 patients in the LM group and 1304 in the TLH group. Patients who underwent LM were younger, more often premenopausal, nonsmokers, with lower body mass index, lower preoperative hemoglobin, larger uterine size, and lower American Society of Anesthesiologists class. LM had longer operative times (154.1 ± 74.5 vs 145.9 ± 70.5 min, p <.0001), higher use of intraoperative hemostatic agents (25% vs 9.1%, p <.0001), and higher estimated blood loss (222.7 ± 313.0 vs 87.4 ± 145.9 mL, p <.0001) than TLH. Postoperatively, LM was associated with fewer surgical site infections (3.1% vs 5.8%, p <.0001), readmissions within 30 days (2.0% vs 5.6%, p <.0001), or emergency department visits within 90 days (10.9% vs 14.4%, p=.008). LM were more likely to be admitted 24 hours postoperatively (5.9% vs 3.4%, p=.0023) or receive a blood transfusion within 30 days (4.0% vs 1.0%, p <.0001). Variables associated with increased risk of postoperative complications were tobacco use, American Society of Anesthesiologists class > 3, preoperative anemia, estimated blood loss ≥ 150 mL, and specimen weight > 250 g. Logistic regression demonstrated that operative time ≥185 minutes was most strongly associated with 24-hour admission postoperatively (odds ratio [OR]=12.95; 95% confidence interval [CI], 3.71-45.27). In individuals ≤ 37 years of age, the LM group was less likely than the TLH group to experience surgical site infection (OR, 0.30; 95% CI, 0.14-0.62) or present to the emergency department (OR, 0.40; 95% CI, 0.26-0.63). In this large cohort of patients, both LM and TLH had low rates of postoperative complications, but the complications differed for each approach. In appropriate surgical candidates, either approach may be offered based upon patients' goals.