Laparoscopic Myomectomy Group Research Articles

Экстракорпоральное оплодотворение и перенос эмбрионов у пациенток после различных методов оперативного лечения миомы матки

Objective. To assess the efficacy of in vitro fertilization (IVF) and embryo transfer in patients who had gone surgical treatment for uterine fibroids using different methods. Patients and methods. This study included 133 patients who were divided into 4 groups depending on the type of treatment for uterine fibroids: no treatment (Group 1), laparotomic or laparoscopic myomectomy (Group 2), hysteroscopic resection of uterine fibroids (Group 3), and uterine artery embolization (UAE) (Group 4). Results. The total number of IVF cycles per patient was 1.8 ± 0.4 after laparoscopic myomectomy, 2.0 ± 0.4 after laparotomic myomectomy, 0.4 ± 0.2 after hysteroscopic resection, 2.1 ± 0.3 after no treatment, and 3.9 ± 0.5 after UAE. Mean number of punctures was 1.3 ± 0.4 after laparoscopic myomectomy, 1.4 ± 0.2 after laparotomic myomectomy, 2.4 ± 0.7 after hysteroscopic resection, 1.4 ± 0.7 after no treatment, and 2.1 ± 0.3 after UAE. Mean number of embryo per patient was 3.8 ± 0.1 after laparoscopic myomectomy, 3.7 ± 0.5 after laparotomic myomectomy, 2.8 ± 0.6 after hysteroscopic resection, 2.7 ± 0.2 after no treatment, and 2.2 ± 0.7 after UAE. Cumulative pregnancy rate was 28.0% after laparoscopic myomectomy, 21.0% after laparotomic myomectomy, 12.0% after hysteroscopic resection, 18.3% after no treatment, and 4.6% after UAE. The take-home baby rate was 30.0% after laparoscopic myomectomy, 23.8% after laparotomic myomectomy, 18.2% after hysteroscopic resection, 16.7% after no treatment, and 4.8% after UAE. Conclusion. The efficacy of IVF and embryo transfer after treatment for uterine fibroids is determined by numerous factors, including age, ovarian reserve, size of fibroids, methods used for treatment of uterine fibroids, time between surgical treatment and IVF and embryo transfer. In women planning pregnancy and treatment of uterine fibroids by uterine artery embolization, especially over 35 years of age, it is advisable to use IVF protocols for cryopreservation of oocytes or embryos before surgery. Key words: infertility and uterine fibroids, uterine fibroids and IVF, myomectomy and IVF, uterine artery embolization, efficiency of IVF and embryo transfer

Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy.

To determine whether or not the risk of recurrence of uterine leiomyoma (UL) was different between laparoscopic myomectomy (LM) and open myomectomy (OM). This study combined a multicenter cohort study with a meta-analysis. The cohort study included women aged 18-44years with 1-3 leiomyomas who underwent LM or OM for UL at one of three teaching hospitals. The meta-analysis included trials comparing recurrence rates of UL between OM and LM. A total of 396 patients (LM: n = 83; OM: n = 313) were recruited in the cohort study. For women aged 18-44years with 1-3 leiomyomas, surgical approach (LM vs. OM) was not an independent risk factor of UL recurrence (31.3% vs. 34.2%, P = 0.571), and the reoperation rate of UL was similar between the LM and OM (2.4% vs. 4.2%, P = 0.726). A total of 2566 patients were meta-analyzed. The recurrence of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas (OR 1.10; 95% CI 0.76-1.61; P = 0.610; I2 = 0%), while the recurrence rate in LM group was higher when the patients had > 5 leiomyomas (OR 1.50; 95% CI 1.14-1.97; P = 0.004; I2 = 38%). From the meta-analysis, the recurrence rate of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas, while the recurrence of LM was higher when the number of leiomyomas was > 5. The cohort study partially supported this conclusion and it further proved the reoperation rate of UL was also similar among women aged 18-44years with ≤ 3 leiomyomas. Therefore, OM should be considered for patients with > 3 or 5 leiomyomas if myomectomy has already been chosen.

Short-term quality of life after myomectomy for uterine fibroids from the COMPARE-UF Fibroid Registry

Uterine fibroids may decrease quality of life in a significant proportion of affected women. Myomectomy offers a uterine-sparing treatment option for patients with uterine fibroids that can be performed abdominally, laparoscopically (with or without robotic assistance), and hysteroscopically. Quality of life information using validated measures for different myomectomy routes, especially hysteroscopic myomectomy, is limited. To compare women's perception of their short-term health-related quality of life measures and reported time to return to usual activities and return to work for different routes of myomectomy. Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) is a prospective nationwide fibroid registry that enrolled premenopausal women seeking treatment for uterine fibroids at 8 clinical sites. For this analysis, we included women undergoing hysteroscopic, abdominal, or laparoscopic myomectomy who completed the postprocedure questionnaire scheduled between 6 and 12 weeks after surgery. Health-related quality of life outcomes, such as pain, anxiety, and return to usual activitie, were assessed for each route. The hysteroscopic myomectomy group had large differences in demographics, fibroid number, and uterine size compared to the other groups; thus, a direct comparison of quality of life measures was performed only for abdominal and laparoscopic approaches after propensity weighting. Propensity weighting was done using 24 variables that included demographics, quality of life baseline measures, and fibroid and uterine measurements. A total of 1206 women from 8 COMPARE-UF sites underwent myomectomy (338 hysteroscopic, 519 laparoscopic, and 349 abdominal). All women had substantial improvement in short-term health-related quality of life and symptom severity scores, which was not different among groups. Average symptom severity scores decreased about 30 points in each group. Return to usual activities averaged 0 days (interquartile range, 0-14 days) for hysteroscopic myomectomy, 21 days (interquartile range, 14-28 days) for laparoscopic myomectomy, and 28 days (interquartile range, 14-35 days) for abdominal myomectomy. After propensity adjustment, quality of life outcomes in the laparoscopic and abdominal myomectomy groups were similar except for more anxiety in the laparoscopic myomectomy group and slightly more pain in the abdominal myomectomy group. After propensity weighting, return to usual activities favored laparoscopic compared to abdominal procedures; median time was the same at 21 days, but the highest quartile of women in the abdominal group needed an additional week of recovery (interquartile range,14.0-28.0 for laparoscopic versus 14.0-35.0 for abdominal, P < .01). Time to return to work was also longer in the abdominal arm (median, 22 days; interquartile range, 14-40 days, versus median, 42; interquartile range, 27-56). Women who underwent myomectomy had substantial improvement in health-related quality of life, regardless of route of myomectomy. After propensity weighting, abdominal myomectomy was associated with a nearly 2-week longer time to return to work than laparoscopic myomectomy.

2570 What's the Limit of Total Laparoscopic Myomectomy?∼In Terms of Intraoperative Conversion∼

Video Objective To assess what limit to complete surgical procedure of laparoscopic myomectomy (LM), I review surgical outcomes of cases performed LM, laparoscopy-assisted myomectomy (LAM) and abdominal myomectomy (AM), and present the cases converted from LM to LAM. Design Retrospective cohort study. Setting Urban general hospital in Japan. Patients All women who were underwent myomectomy, between 2014 to 2018. Interventions Medical records were reviewed for baseline characteristics and perioperative outcomes. Measurements and Main Results First, I present our operative procedure of LM. We have modified diamond trocar placement.After the vasopressin injection into the myometrium of fibroid surface,we make incisions with ultrasonic or electric scalpel and enucleate fibroids. After the suturing of myometrium, we make posterior colpotomy and carry out them transvaginally. If fibroids are too large to be carried out, we perform intracorporal or intravaginal manual morcellation. Second, A total of 1123 patients were undergone myomectomy in our hospital between 2014 to 2018. The mean ±SD specimen weight of LM, LAM, AM was 180.5±153, 597.0±389.1, 972.9±738.9g, dominant myoma diameter was 6.7±2.4, 10.3±3.6, 12.8±5.8cm. 4 out of 1029 (0.39༅) LM cases were shifted to LAM during surgery, one case due to numerous myoma and three cases due to severe intraabdominal adhesion. No difference in perioperative complications was found for LM group with other procedures. All cases were performed blood test and imaging test by ultrasonography or magnetic resonance imaging (MRI) preoperatively. When a malignancy is suspected, the specimen is extracted using a protection bag. In 1123 cases performed uterus-preserving surgery, only 1 case (0.09%) was revealed as malignant postoperatively. Conclusion LM is feasible and safe surgical procedure with appropriate selection of patients.

Ultrasonographic Features of Uterine Scar after Laparoscopic and Laparoscopy-Assisted Minilaparotomy Myomectomy: A Comparative Study

To evaluate uterine scar features after laparoscopic myomectomy (LM) compared with myomectomy performed by laparoscopy initially and then completed with minilaparotomy (LAM). Prospective cohort study. An academic center for advanced endoscopic gynecologic surgery. Sixty-nine symptomatic women who underwent myomectomy between July and December 2018. Patients underwent LM or LAM and 3-month follow-up ultrasonography. Forty-four patients underwent LM and 25 underwent LAM. Demographic data, intraoperative parameters, and postoperative outcomes were collected. Two-dimensional color Doppler ultrasound was done at a 3-month follow-up to evaluate myomectomy scar features, myometrial thickness, and the presence of and vascularity of a heterogeneous mass. These features were compared with those of the intact myometrium on the opposite wall of the patient's uterus. The 2 groups had similar demographic characteristics, and there were no significant between-group differences in the number, maximum diameter, type, or location of myomas. The mean myometrial thickness at the scar site was 18.9 ± 3.22 mm in the LM group and 19.7 ± 3.50 mm in the LAM group, with no significant difference between the 2 groups. There was no meaningful difference in vascularity between the scar and normal myometrium. Heterogeneous masses were detected in 23% of patients in the LM group and in 24% of those in the LAM group. Other than mean operative time (207 minutes for LM vs 150 minutes for LAM; p < .001) and mean postoperative reduction in hemoglobin (1.77 mg/dL for LM vs 2.35 mg/dL for LAM; p = .023), there were no other statistical differences between the 2 groups. One patient in the LM group experienced a bowel injury resulting from morcellation. There were no differences in myometrial scar features after LM compared with after LAM, implying effective suturing via both approaches.

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.

Comparison of 30-day Complication Rates between Laparoscopic Myomectomy and Total Laparoscopic Hysterectomy for the Treatment of Uterine Leiomyoma in Women Older Than Age 40

To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women. A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2). American College of Surgeons National Surgical Quality Improvement Program database. Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016. Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication. After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, p = .03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, p = .54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, p = .01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR] = 8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aOR = 5.91; 95% CI, 1.7-9.63), total operating time (aOR = 1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aOR = 3.67; 95% CI, 2.31-5.8). LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata.

Six-year survival of patients with unsuspected uterine malignancy after laparoscopic versus laparotomic myomectomy: An 11-year national retrospective cohort study

ObjectiveThe primary objective was to compare the overall survival of women with unsuspected uterine malignancy (UUM), including sarcomas and adenosarcomas, diagnosed after laparotomic versus laparoscopic myomectomy. The secondary objective was to determine the incidence of UUM diagnosed after myomectomy. MethodsWe analyzed the national health insurance database, which covers almost the entire Korean population, between 2006 and 2010 to calculate the incidence and mortality of UUM diagnosed after myomectomy. Diagnosis and procedure codes were used to identify women with or without UUM. ResultsDuring the study period, 78,826 patients who underwent myomectomy among women in the database (23 million per year) were enrolled. The women were divided into a laparotomic myomectomy group (n = 56,213) and a laparoscopic myomectomy group (n = 22,613). The incidence of UUM diagnosed after myomectomy was 0.08% in both groups (47/56,213 and 18/22,613 women, respectively). There was no difference in mean age, socioeconomic status, diagnostic code, UUM incidence at 5-year intervals, survival rate, or mean survival time. The 5-year survival rates of women with UUM were 95.7% and 88.9% in the laparotomic and laparoscopic groups, respectively. A Kaplan-Meier survival analysis showed no difference in the overall survival rates according to the surgical method (P = 0.447). ConclusionsThe incidence of UUM after myomectomy was 0.08% after laparotomic or laparoscopic myomectomy. Although morcellator use does not reduce the overall survival rate, clinicians should explain the risks of intraperitoneal tumor dissemination to patients and do their best to prevent tumor spillage when using this tool.

A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

ObjectiveUltraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision) and conventional 3-port wound laparoscopic myomectomy (LM) approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures. Materials and methodsBetween January 2002 and December 2003, 71 patients undergoing UMLT-M were compared with those 71 women undergoing LM. The last data collection for all patients was done on 31 December 2016. The parameters for comparison included the characteristics of the uterine myomas, surgical parameters, morbidities, and outcomes. Surgical parameters included the operative time (minutes), estimated blood loss (milliliters), time for removal of drainage, percentage of blood transfusion and co-morbidities. ResultsMean operative time in the LM group was significantly longer than that in the UMLT-M group (208.7 ± 65.9 vs. 98.0 ± 28.2 min, p < 0.001). Intra-operative blood loss was significantly higher in the LM group than that in the UMLT-M group (210.9 ± 184.5 vs. 111.7 ± 108.4 ml, p < 0.001). However, more patients had postoperative fever in the UMLT-M group (39.4% vs. 8.5%, p < 0.001). The recurrence rate of myoma at 5-year follow-up was significantly different between two groups (35.2% of UMLT-M vs. 57.7% of LM, p = 0.007), but there was no difference when follow-up time was over ten years. The location of the myoma recurrence was different between two groups with higher recurrence rates in the fundal and lateral sides of uterus in the UMLT-M group and in the anterior wall of uterus in the LM group. However, the overall symptom control, the need of repeated myoma-related surgery and subsequent pregnancy outcome of both groups seemed to be similar in both groups. ConclusionsMore operative time and more blood loss reflected that LM demanded skills, experience and equipment. Therefore, UMLT-M might be a feasible alternative choice in the management of uterine myomas, since it is an easy-to-perform and familiar technique, especially in the absence of suitable equipment or skilled operator. A large and randomized study is needed to confirm the above findings.

Five-Year Lapsed: Review of Laparoscopic Myomectomy versus Open Myomectomy in Putrajaya Hospital.

Study Objective:This study aimed to investigate the morbidity of laparoscopic myomectomy (LM) versus open myomectomy (OM), including intraoperative blood loss, duration of surgery, hospital stay, and complications and to evaluate the criteria for selection of cases suitable for LM.Design:This was a retrospective study.Setting:This study was conducted at tertiary hospital.Participants:The records of 67 women who underwent LM, 22 women who underwent OM, and 14 women who had laparo-conversion from January 2010 to November 2014 were reviewed.Measurement and Main Results:Fibroids up to 10 cm were removed by LM, while most fibroids more than 10 cm were managed through OM. The number and weight of myomas are significantly associated with laparo-conversion, with a rate of 17%. Mean blood loss was significantly reduced in LM group than the OM and laparo-conversion groups. Duration of hospital stay was also significantly less in LM (2 ± 1 days) compared to both OM and laparo-conversion groups (3 ± 1 days). Most women underwent LM (88%) had no postoperative complications compared to OM (50%) and laparo-conversion (57.1%). The number of fibroids removed and duration of surgery was positively correlated with blood loss in the women who underwent myomectomy.Conclusion:LM is an ideal surgical approach for removal of fibroids which are up to 10 cm diameter and <5 in number, while OM is useful for cases with multiple (5 or more), larger fibroids (>10 cm), and deeply located fibroids. Preoperative evaluation of the size and number of myomas is necessary to avoid laparo-conversion and to reduce intraoperative and postoperative complications.

Analysis of the effect of laparoscopy and hysteroscopy on ovarian function, immune function and quality of sexual life of patients with hysteromyoma at different ages.

This study aims to comparatively analyze the impact of laparoscopic myomectomy (LM) and transcervical resection of myoma (TCRM) on ovarian function, immune function and quality of sexual life of patients with hysteromyoma. Two hundred and forty patients with hysteromyoma admitted into the Second Affiliated Hospital of Zhengzhou University from June 2014 to June 2016 were divided into laparoscopic myomectomy group (LM group, n=120) and transcervical resection of myoma group (TCRM group, n=120) according to random figure table. The difference between the two surgical methods were compared among hysteromyoma patients of different age in the following aspects: perioperative indicators, ovarian function, immune function and quality of sexual life before treatment and after operation. 1) there was no significant difference in age structure between LM and TCRM group (P>0.05). 2) There were no significant differences in the amount of bleeding, operative time, analgesics usage rate between the groups (P>0.05), but the anal exhaust time, postoperative ambulation time, hospitalization time and hospitalization costs in TCRM group were significantly less than that in LM group, the difference was statistically significant (P<0.01). 3) Before treatment and in the 3rd, and 6th month after operation, there was no significant difference on follicle stimulating hormone (FSH), luteinizing hormone (LH) or estradiol (E2) level between the two groups (P>0.05); but in the 3rd month after operation, the level of E2 decreased remarkably, with FSH and LH level increased significantly compared with the 6th month after operation and before treatment (P<0.05). 4) Compared with the preoperative status, there was no significant decrease in humoral immunity (IgG, IgA, IgM) and cellular immune function (CD4+, CD8+) in TCRM group at the 3rd and 6th month after operation (P>0.05). While at the 3rd month after operation, the levels of CD4+, CD8+ were decreased significantly in comparison to those at the 6th month after operation (P<0.05), but the levels of IgG, IgA and IgM were not decreased significantly (P>0.05). 5) There was no significant difference in the quality of sexual life between the two groups before operation or at the 3rd and 6th month after operation (P>0.05). In recent years, endoscopic treatment has become the main treatment evolution of hysteromyoma, patients of all ages are paying attention to the preservation of the uterus. This study showed that TCRM is approaching through the natural cavity, which has the features of less damage to body, faster recovery and lower cost of hospitalization than LM. The two surgical methods have no obvious influence on ovarian function, immune function and quality of sexual life.

Recurrence factors and reproductive outcomes of laparoscopic myomectomy and minilaparotomic myomectomy for uterine leiomyomas.

ObjectiveThe aim of this study was to determine recurrence factors and reproductive outcomes of laparoscopic myomectomy (LM) and minilaparotomic myomectomy (MM) for treating uterine leiomyomas.MethodsBetween 2007 and 2013, 160 patients underwent myomectomy, including 122 who underwent LM and 38 who underwent MM. Patients were followed up for recurrence based on pelvic ultrasound exams. Only patients who were followed up for a minimum of two years were selected for this retrospective study. Pregnancy rate, delivery, and delivery methods were compared between the two groups to evaluate reproductive outcomes. Furthermore, mean age, body mass index, preoperative administration of gonadotropin-releasing hormone agonist (GnRHa), and characteristics of leiomyomas were investigated to determine recurrence factors.ResultsThe mean body mass index in the MM group was significantly (P=0.048) higher than that in the LM group. The number and the largest diameter of removed leiomyoma were also significantly higher in the MM group (both P=0.001). Logistic regression after adjusting significantly different characteristics showed that the LM group had shorter (P=0.020) postoperative hospitalization days compared to the MM group. Other outcome variables including recurrence rate were not significantly different between the two groups. Reproductive outcomes such as pregnancy rate, delivery, and delivery methods were not significantly different between the two groups. Preoperative GnRHa therapy was the only significant (P=0.039) recurrence factor after myomectomy.ConclusionThis study showed that LM and MM had similar recurrence rates and reproductive outcomes. The only recurrence factor of significance was preoperative administration of GnRHa.

Multicentre study to evaluate the clinical effects of laparoscopic uterine artery occlusion in combination with myomectomy to treat symptomatic uterine leiomyomas

ObjectiveUterine artery occlusion is often used to treat symptomatic uterine myomas, as this is a minimally invasive approach. However, alternative methods for uterus-sparing therapy are in development. This study aimed to compare the clinical effects of laparoscopic uterine artery occlusion (LUAO) in combination with laparoscopic myomectomy (LM) with LM alone for the management of symptomatic uterine leiomyomas. Study designThis multicentre study was a retrospective controlled investigation. In total, 618 patients with symptomatic uterine myomas from six hospitals in Eastern China underwent LUAO+LM or LM alone between June 2011 and December 2012. Operative time, blood loss, transfusion, highest temperature, postoperative hospital stay, complications and follow-up results were compared between the two groups. ResultsComplete clinical data were available for 504 patients. Among these, 324 patients underwent LUAO+LM and 180 patients underwent LM alone. Mean±standard deviation blood loss, transfusion, highest peri-operative temperature and duration of hospital stay were significantly lower in the LUAO+LM group compared with the LM group (83.61±53.70ml vs 109±58.43ml, 1.85% vs 6.11%, 37.6±0.40°C vs 37.9±0.45°C and 5.11±0.62 days vs 6.10±0.83 days, respectively). The mean duration of follow-up was 38.97±5.82 months in the LUAO+LM group and 37.30±2.25 months in the LM group (p>0.05). The relief of abnormal uterine bleeding, reduction of uterine volume and recurrence of myomas were more remarkable in the LUAO+LM group than the LM group (97.22% vs 83.75%, 62.42% vs 51.83% and 3.47% vs 10.63%, respectively). ConclusionsLUAO in combination with LM was associated with higher surgical quality, greater relief of abnormal symptoms and less recurrence of myomas compared with LM alone. LUAO in combination with LM is recommended for women with symptomatic uterine myomas who wish to preserve their uterus.

Laparoendoscopic single-site myomectomy compared with conventional laparoscopic myomectomy: a multicenter, randomized, controlled trial

To compare surgical outcomes of laparoendoscopic single-site myomectomy (LESS-M) vs. conventional laparoscopic myomectomy (LM). Multicenter, noninferiority, randomized, controlled trial. University hospitals. A total of 100 subjects with symptomatic uterine myomas were randomly assigned to either LESS-M or conventional LM. Surgical outcomes were comparatively assessed between the groups on the basis of the intention-to-treat principle. Laparoscopic myomectomy. The time required for uterine defect suturing. There were no differences in baseline demographics (age, body mass index, surgical indication, number of myomas, and size and location of the largest myoma) between the two groups. The suturing time (mean ± SD) was 21.9 ± 10.7 minutes (95% confidence interval 18.8-24.9 min) for the LESS-M group and 23.3 ± 12.4 minutes (95% confidence interval 19.8-26.9 min) for the conventional LM group, with no significant difference between the two groups. The other surgical outcomes, such as total operative time, operative blood loss, postoperative hemoglobin change, degree of surgical difficulty, postoperative pain scores, operative complication, and length of hospital stay, were similar between the two groups. Three subjects (6%) assigned to the LESS-M group underwent conventional LM because of difficulty in myoma enucleation and suturing, whereas no failure to intended procedure occurred in the conventional LM group (6% vs. 0). Laparoendoscopic single-site surgery is a feasible and safe treatment option for myomectomy that offers surgical outcomes comparable to those with conventional LM. NCT01984632.

Abdominal ve Laparoskopik Myomektomilerin Postoperatif Komplikasyonlar ve Fertilite Açısından Değerlendirilmesi

Objective: The aim of this study is to compare the postoperative complications of laparoscopic and abdominal myomectomy procedures for the myoma of uterus and their effects on postoperative fertility.Material and Methods: In this study, we retrospectively evaluated 221 cases who were performed myomectomy operation at Suleymaniye Obstetrics and Gynecology Hospital between 2003-2007. All cases were divided into two groups with respect to the surgical procedure performed. 136 patients were in the abdominal myomectomy (AM) group, 85 patients were in the laparoscopic myomectomy group and the groups were compared. Results: There is no significant difference in age, smoking, history of abdominal surgery, pelvic infection, postoperative need for transfusion, and ileus between the groups. The mean number of parity was higher in the laparoscopic myomectomy group. In abdominal myomectomy group, number of cases in which more than 4 myomas were removed (p<0.01) and number of cases in which myoma was greater than 6 cm in diameter (p<0.001) were higher than laparoscopic myomectomy group. The operation time and duration of hospital stay was longer (p <0.001), while postoperative hemotocrit levels were lower in abdominal myomectomy group when compared with laparoscopic myomectomy group (p<0.017). Postoperative cumulative pregnancy rate and pregnancy by assisted reproductive technology is higher in laparoscopic myomectomy group than abdominal myomectomy group ( p<0,001).Conclusion: There was no difference between the groups in complications during and after the operations, while laparoscopy was more advantageous than abdominal surgery with shorter time of surgery and hospital stay, less bleeding during the procedure and higher rates of pregnancy postoperatively

Clinical analysis of 190 patients with myomectomy by laparoscope

Objective To investigate the clinical effect of laparoscopic operation and laparotomy in the treatment of uterine fibroids. Methods A retrospective analysis of uterine fibroids and requests to retain the clinical data of 380 cases of uterine of patients, according to treatment methods, they were divided into laparoscopic myomectomy group(group A)and cesarean section uterine fibroids removed surgery group(B group), there were 190 cases, two groups of patients, surgery, clinical effect were analyzed. Results In group A,operation time, postoperative exhaust time,postoperative ambulation time, postoperative VAS score, duration of hospitalization, injection of analgesics application proportion were(96±35)min,(24±8.5)h,(12±4)h,(2.0±1.5),(4.0±1.2)d,17.8%,patients in the group B respectively(98±28)min,(40±12)h,(20±8)h,(6.0±1.3), (8±2)d,84.6% there was a significant differences between the two groups(t=- 2.558,33.96,45.810,50.571,34.120,χ2= 169.89,all P 0.05);group A,the complication rate was 7.34%,lower than the 12.6% in the group B,there was significant difference between the two groups(χ2= 3.923,P< 0.05). Conclusion Laparoscopic myomectomy in treatment of uterine fibroids, good effect, less trauma, quicker recovery, shorter hospitalization time of patients, should be further popularized in clinic. Key words: Laparoscopy; Uterine fibroids; Obsterics and gynecology operation

Minimally invasive surgical techniques versus open myomectomy for uterine fibroids.

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. To determine the benefits and harms of laparoscopic or hysteroscopic myomectomy compared with open myomectomy. 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. 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. 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. 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. 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.

Analysis of the risk factors for postoperative residue, relapse following myomectomy

To elaborate the risk factors for leiomyoma residue and relapse after different approaches of myomectomy. From Jan. 2005 to Dec. 2010 and Jan. 2011 to Jan. 2013, 769 patients underwent myomectomy were recruited in Beijing Obstetrics and Gynecology Hospital. The patients demographic, leiomyoma characteristics, preoperative gonadotropin-releasing hormone agonist (GnRH-a) therapy, surgical approach, pathological type, follow-up information were collected. Leiomyoma number was the risk factor of postoperative residue and relapse, with the leiomyoma number increased one, the risk of residue and relapse increase 1.085 times (OR = 1.085, 95% CI: 1.019-1.154, P = 0.010), 1.043 times (RR = 1.043, 95% CI: 1.014-1.073, P = 0.003) respectively. Leiomyoma type (intramural leiomyoma) was the risk factor of relapse (RR = 1.665, 95% CI: 1.029-2.693, P = 0.038). Age was not the risk factor for postoperative residue rate (P = 0.828) and relapse rate (P = 0.193). GnRH- a didn't increase the postoperative residue and relapse rate (P = 0.542, 0.133). The postoperative residue rate (P = 0.764), relapse rate (P = 0.279) between transabdominal and laparoscopic myomectomy groups had no significant difference. Bizarre leiomyoma (RR = 5.678, 95% CI: 1.373-23.490, P = 0.017) and celluar leiomyoma (RR = 2.201, 95% CI: 1.466-3.303, P < 0.01) were the risk factors for postoperative relapse rate. Leiomyoma number, leiomyoma type (intramural leiomyoma) are the main risk factors for postoperative relapse. Pretreatment of GnRH-a and laparoscopic approach wouldn't increase the rate of residue and relapse. Bizarre leiomyoma and cellular leiomyoma have a higher relapse rate than common leiomyoma.

Laparoscopic Myomectomy Versus Uterine Artery Embolization: Long-Term Impact on Markers of Ovarian Reserve

ObjectiveTo compare the relative long-term effects on ovarian reserve of treating fibroids in reproductive-aged women with uterine artery embolization (UAE) versus laparoscopic myomectomy (LM), using sensitive measures including antral follicle count (AFC) and serum anti-Müllerian hormone (AMH). MethodsWe undertook a retrospective cohort pilot study to evaluate the utility and feasibility of carrying out a larger prospective trial. Thirteen women were evaluated in this study, including eight in the UAE group and five in the LM group. They were identified from a larger group of 125 women who had undergone LM and 200 women who had undergone UAE at a participating institution at least 12 months previously; of these, 32 who had UAE and 27 who had LM were of reproductive age and eligible to participate. Participants had an assessment of ovarian reserve including measurements of serum AMH, estradiol, and FSH, and ultrasound assessment of AFC and ovarian volume. ResultsMedian serum AMH levels were significantly lower in women who had undergone UAE at least 12 months previously than in women who had undergone LM (0.78 ng/mL [range 0.67 to 1.28] vs. 2.17 ng/mL [range 1.17 to 2.38], P = 0.01). Median AFC per ovary was also significantly lower in women who had UAE than in those who had LM (3.5 [range 2 to 7] vs. 7 [range 6 to 11], P = 0.03). Median levels of FSH and E2 and of ovarian volume were not significantly different between the two groups. ConclusionReproductive-aged women who have undergone treatment of fibroids with UAE may have lower ovarian reserve over the long term (> 12 months) than women with fibroids treated with LM. This could have an adverse impact on future response to fertility treatment and/or fecundity. This finding may inform the choice of minimally invasive treatment for fibroids in reproductive-aged women who have not completed childbearing. It suggests that further study in this area is warranted before the application of UAE is expanded to young reproductive-aged women.

Laparoscopic radiofrequency volumetric thermal ablation of fibroids versus laparoscopic myomectomy

ObjectiveTo compare the mean hospital discharge times and perioperative outcomes for radiofrequency volumetric thermal ablation (RFVTA) of fibroids and laparoscopic myomectomy (LM). MethodsThe present postmarket, randomized, prospective, single-center, longitudinal, comparative study, conducted in Tübingen, Germany, evaluated the outcomes of RFVTA and the current standard of care (LM) for symptomatic uterine fibroids in women who desired uterine conservation. The surgeons were blinded to the treatment until all fibroids had been mapped by laparoscopic ultrasound. ResultsThe mean hospitalization times were 10.0±5.5 (median 7.8 [range 4.2–25.5]) hours for the RFVTA group and 29.9±14.2 (median 22.6 [range 16.1–68.1]) hours for the LM group (P<0.001, Wilcoxon test). Intraoperative blood loss was 16±9 (median 20 [range: 0–30]) mL for the RFVTA procedures and 51±57 (median 35 [range 10–300]) mL for the LM procedures. The percentage of fibroids imaged by laparoscopic ultrasound that were treated/excised was 98.6% for RFVTA and 80.3% for LM. Two complications were reported: vertigo (n=1; RFVTA) and port site hematoma (n=1; LM). ConclusionRadiofrequency volumetric thermal ablation resulted in the treatment of more fibroids, a significantly shorter hospital stay, and less intraoperative blood loss than laparoscopic myomectomy.ClinicalTrials.gov:NCT01750008