Laparoscopic myomectomy with power morcellation is a common approach for the management of uterine myomas. However, besides myoma recurrence, rare complications such as peritoneal leiomyomatosis may arise postoperatively. The histopathological subtype of fibroids-particularly cellular leiomyoma-may impact the risk of recurrence and dissemination, though current evidence remains limited. The aim of this study is to evaluate the impact of power morcellation on the development of disseminated peritoneal leiomyomatosis and to assess the association between the histopathological subtype of myoma and patient outcomes during follow-up. This retrospective cohort study analyzed 997 patients who underwent laparoscopic myomectomy with power morcellation at a single tertiary center between 2012 and 2024. Patients were followed through clinical evaluations and ultrasonography. Peritoneal leiomyomatosis was evaluated in relation to surgical technique (confined vs. unconfined morcellation) and histopathological subtype. Of the 553 patients with available follow-up, myoma recurrence was observed in 130 (23.5%), reoperation in 53 (9.6%), and peritoneal leiomyomatosis in 8 patients (1.4%). All peritoneal leiomyomatosis cases occurred in the unconfined morcellation group. Cellular leiomyoma was identified in 5 of the 8 peritoneal leiomyomatosis cases (62.5%). One peritoneal leiomyomatosis case was diagnosed as leiomyosarcoma after surgery for disseminated leiomyomatosis. Overall myoma recurrence was significantly higher in patients with multiple myomas and in those with cellular leiomyoma. Peritoneal leiomyomatosis is a rare complication of laparoscopic myomectomy and increased incidence after unconfined morcellation is a serious concern. Confined (in-bag) morcellation appears to reduce the risk of peritoneal leiomyomatosis and should be the standard of care. Diagnosis of myomas as cellular leiomyoma subtype on histopathology merits high clinical suspicion for possibility of subsequent peritoneal leiomyomatosis in patients with unconfined morcellation. Therefore, close and long-term follow-up of these patients is essential.

Safety of In-Bag Morcellation During Laparoscopic Myomectomy and Hysterectomy: A Systematic Review and Meta-Analysis.

The aim of this study was to explore the application of enhanced recovery after surgery (ERAS) in patients undergoing gynaecological surgery. This investigation included an analysis of the postoperative recovery curve and the factors that influenced the number of postoperative recovery days. This study also aimed to further investigate the impact of various factors on health economics. A retrospective cohort study was conducted in the Fourth Ward of the General Gynaecology Centre of the Peking Union Medical College Hospital. A total of 1000 patients who had undergone elective benign gynaecological surgery between July 2021 and December 2022 were included. Demographic, perioperative and other relevant data were collected, and a visual analogue scale (VAS) survey was conducted using the European Five-Dimensional Health Scale (EQ-5D). The factors that influenced the number of postoperative recovery days were analysed using a multivariate linear regression analysis. Additionally, patients who had undergone laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic total hysterectomy, abdominal myomectomy and abdominal total hysterectomy were grouped based on whether their ERAS implementation rate was ≥70%. Our goal was to evaluate the health economic value of the diagnosis-related group (DRG) payments from multiple perspectives and provide actionable recommendations for health insurance bureaus, hospitals and patients from a multi-dimensional perspective. ERAS completion rates for measures such as avoiding preoperative sedation and early postoperative ambulation exceeded 95%, whereas rates for chewing gum and intraoperative temperature monitoring were <5%. The follow-up EQ-5D questionnaire VAS scores were as follows: a preoperative score of 79.48±13.75, score on the day of surgery of 74.18±15.43, score on the first postoperative day of 76.43±14.25, and score on the second postoperative day of 79.84±13.12. Patients returned to a healthy state with a median recovery time of 3 (range, 0-8) days. The postoperative recovery curve was then drawn based on the VAS scores. Additionally, a multivariate linear regression analysis revealed that the prevention of postoperative nausea and vomiting, correction of preoperative anaemia and malnutrition, ERAS completion rate and VAS score on the second postoperative day significantly influenced the number of postoperative recovery days (p<0.05). Patients with ERAS compliance rates of <70% incurred an average hospital cost increase of 8% compared with those with a compliance rate of ≥70%. Specifically, patients who underwent laparoscopic myomectomy and laparoscopic total hysterectomy experienced more significant and more obvious increases in hospitalisation costs of approximately 15% (p<0.001) and 8% (p=0.031), respectively.An analysis of the relationship between hospital costs and different ERAS measures, insurance types and disease types showed that seven measures could reduce hospital costs without negatively affecting the patient recovery speed, and five measures could slightly increase hospital costs. In addition, hospitalisation cost differences based on various insurance types and disease categories were statistically significant (p<0.05). The postoperative recovery speed was accelerated, the recovery time was shortened and the patient's quality of life was enhanced during gynaecological surgery due to the implementation of ERAS practices. Increasing the ERAS completion rate can significantly reduce patient average hospitalisation costs. Additionally, variations in medical insurance, disease categories and specific ERAS measures influenced these costs. Therefore, hospitals that are unable to fully implement all ERAS measures must prioritise those that promote recovery. In addition, hospitals should adopt flexible strategies to minimise costs, thereby achieving mutual benefits for patients and hospitals. These findings establish a foundation for the implementation of a simplified ERAS version. It has been observed through the perspective of DRG implementation in China that payment standards exceed the average hospitalisation costs associated with specific surgical procedures. This result suggests that DRG implementation can benefit both patients and hospitals. These study results will serve as a valuable reference for decision-making by health insurance bureaus, hospitals and patients.

This report describes the case of a patient in her early 40s with a history of laparoscopic myomectomy who presented to the Beijing Shunyi District Maternal and Child Health Hospital (Beijing, China) in December 2024 with menstrual disturbances and a pelvic mass. The patient had disseminated peritoneal leiomyomatosis, a rare benign neoplastic condition characterized by multifocal smooth muscle nodules on the peritoneal surface. Its nonspecific clinical and radiological features often lead to misdiagnosis as malignant peritoneal carcinomatosis. Pelvic magnetic resonance imaging revealed a 9.5-cm cervical mass, an 11.4-cm right pelvic mass, and multiple T2-hypointense uterine lesions, with the largest lesion measuring 14.9 cm. The patient underwent a total laparoscopic hysterectomy with bilateral salpingectomy and resection of multiple mesenteric tumors, with an aggregate specimen weight of 4600 g. Histopathological examination confirmed benign leiomyomatosis, thereby establishing the diagnosis of disseminated peritoneal leiomyomatosis. This case demonstrates a causal link between uncontained morcellation and disseminated peritoneal leiomyomatosis, underscores the role of magnetic resonance imaging T2 hypointensity in differentiating this benign condition from malignancies such as leiomyosarcoma, and confirms surgery as the cornerstone of management when fertility is not a concern. Long-term surveillance remains imperative due to risks of recurrence and rare sarcomatous transformation. Written informed consent was obtained from the patient for treatment and publication, and all patients details have been deidentified to protect anonymity.

Background. Uterine artery embolization (UAE) is currently widely used to treat uterine fibroids. Despite this, the issue of the effect of UAE on reproductive function remains controversial. Aim. To study the impact of EMA performed for uterine fibroids on women's reproductive function. Materials and methods. A retro- and prospective analysis of the case histories of 100 patients aged 26 to 45 years who underwent UAE for uterine fibroids was conducted. Results. In the majority of cases (96 %), UAE was effective. Repeated UAE was required only in 4 % of patients. Eight (8 %) patients underwent transcervical myomectomy during the first year after UAE. One (1 %) patient underwent laparoscopic myomectomy, one (1 %) – hysterectomy for fibroid necrosis in the second year of observation. Regular menstrual cycle after UAE was observed in 80 % of women, 18 % had an irregular menstrual cycle, which was restored within 12 months after surgery. And 2 % at the age of 45, experienced menopause. Pregnancy occurred in 58 % of patients. 34 (58.5 %) of pregnancies resulted in the first live birth. 13 (21.9 %) were terminated at the request of the women. In 3 (4.9 %) of cases, pregnancy ended in spontaneously miscarriage. In 5 (9.8 %) and 3 (4.9 %) of cases, non-viable and ectopic pregnancy was detected, respectively. The frequency of complications during pregnancy, childbirth and postpartum period in our study did not differ from those in the general population. Conclusion. The use of UAE for the treatment of uterine fibroids in patients of reproductive age planning pregnancy is highly effective alternative to surgical and drug treatment.

BackgroundWe aimed to evaluate the risk of perinatal complications in subsequent pregnancies after different types of myomectomy, viz. open, laparoscopic, or hysteroscopic. Moreover, we investigated whether the time interval from myomectomy to subsequent pregnancy (TIMP) is a risk factor for perinatal complications.MethodsThis retrospective cohort study analyzed data from the vast Japanese health insurance JMDC database between January 2008 and July 2024. We identified primiparous women and excluded participants based on the following criteria: age < 20 years at delivery, diagnosis of adenomyosis, multiple pregnancy, or history of repeated myomectomy using different approaches. The occurrence of placenta accreta spectrum (PAS), placenta previa, uterine rupture, gestational hypertension/preeclampsia, and placental abruption was compared among women who underwent open, laparoscopic, or hysteroscopic myomectomy and those in the control group. Subsequently, for each myomectomy procedure, we compared the TIMP between women with and without each perinatal complication. Fisher’s exact test and multivariable logistic regression models were employed.ResultsAmong the 27,129 eligible women, 140, 305, and 97 underwent open, laparoscopic, and hysteroscopic myomectomy, respectively. The proportion of PAS was the highest in the hysteroscopic group (5.2%), followed by the control (1.8%), open (1.4%), and laparoscopic (1.3%) groups. After adjustment, there was no association between PAS and hysteroscopic myomectomy (adjusted odds ratio, 1.86; 95% confidence interval, 0.75–4.63). Uterine rupture after myomectomy was observed only in the laparoscopic surgery group (1.0%); this difference among the four groups was statistically significant (Fisher’s exact test, P = 0.001), although a robust adjusted analysis was not feasible due to the low incidence rate. The proportion of gestational hypertension/preeclampsia was the highest in the hysteroscopic group (17.5%); however, a similar trend was observed as for PAS (adjusted odds ratio, 1.30; 95% confidence interval, 0.74–2.27). The incidences of placenta previa and placental abruption did not differ significantly among the groups. The TIMP was the shortest after hysteroscopic myomectomy, followed by laparoscopic and open myomectomy. Although the number of outcomes was small, which constrained clinical interpretation, there were no perinatal complications associated with TIMP.ConclusionOur study suggested the potential risk of uterine rupture after laparoscopic myomectomy. The optimal TIMP remains unclear. The risks of perinatal complications after myomectomy should be assessed and addressed at the individual level based on the specific myomectomy method, but further research on the optimal TIMP is warranted.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12884-025-08617-6.

Pregnancy outcomes after laparotomic or laparoscopic myomectomy: A multicenter retrospective cohort study.

A case-controlled cost and clinical outcomes analysis comparing transvaginal radiofrequency conservative treatment of uterine myomas and surgical treatment by myomectomy or hysterectomy in a teaching hospital.

The effectiveness of relugolix compared with leuprorelin for preoperative therapy before laparoscopic myomectomy: a randomized controlled noninferiority study (MyLacR study).

Chronic pelvic inflammatory disease with multiple myometrium abscesses: A case report and literature review.

Uterine fibroids are the most common benign tumors affecting women of reproductive age, often requiring surgical intervention. This meta-analysis and systematic review compared the effectiveness, safety, and cost of three surgical approaches: robotic-assisted laparoscopic myomectomy (RLM), traditional abdominal myomectomy (AM), and laparoscopic myomectomy (LM). Following PRISMA guidelines, we systematically searched PubMed, EMBASE, and Google Scholar databases for studies published through January 2024, with no restrictions on publication date. Fifteen studies were included in the qualitative synthesis, and nine studies in the meta-analysis, comprising 2,559 patients. Our findings revealed that AM had significantly shorter operative time compared to RLM (mean difference: 82.54 minutes; 95% CI: -122.14, -42.93; P < 0.00001; I² = 94%). However, RLM was associated with significantly shorter hospital stays than AM (mean difference: 1.54 days; 95% CI: 1.31 to 1.77; P≤0.00001; I²=58%). No significant differences were found in operative time (mean difference: 36.47 minutes; 95% CI: -11.58, 84.51; P = 0.14) or blood loss between RLM and LM. Intraoperative bleeding (EBL >1000 mL) was most common in AM (7.0%) compared to RLM (1.3%) and LM (2.6%). Postoperative transfusion rates were highest in AM (20%), followed by LM (5.8%) and RLM (3.8%). The study demonstrated substantial heterogeneity (I² > 75% for most outcomes), attributed to differences in patient characteristics and study designs. In conclusion, RLM provides favorable outcomes with shorter hospital stays and fewer complications compared to AM, while showing comparable results to LM, though at potentially higher cost.

Three-dimensional printing model-assisted single-port laparoscopic multiple myomectomy: a randomized controlled trial

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disorder of uncertain aetiology that often mimics advanced ovarian or peritoneal malignancy, both clinically and radiologically. The majority of reported cases have been associated with prior laparoscopic uterine myomectomy, particularly when uncontained morcellation was used. Here, we present a case of a nulliparous woman in her 20s who presented with a large abdominopelvic mass and radiological findings suggestive of ovarian carcinoma. However, further history-taking revealed a laparoscopic myomectomy with morcellation performed 2 years earlier for primary infertility due to a large intramural fibroid. Subsequent ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis of disseminated peritoneal leiomyomatosis (DPL). The objective of this case report is to highlight the diagnostic challenge DPL poses by mimicking malignancy and to emphasise the importance of eliciting prior surgical history-particularly involving morcellation-as a crucial clue in correctly identifying this benign entity.

Esketamine improves postoperative sleep quality in women undergoing gynecological laparoscopy: A prospective, randomized, double-blind, and controlled trial.

Perioperative anesthetic management in a patient with Gitelman syndrome undergoing single-port laparoscopic myomectomy: A case report

ObjectiveThe aim of this study is to evaluate the incidence of shoulder pain after single port transumbilical laparoscopic myomectomy and analyze patient and operative specific factors associated with post-laparoscopy shoulder pain (PLSP). This information can inform preoperative risk assessment and intervention.MethodThis is a prospective cohort study. Two hundred and twenty patients undergoing elected single-port laparoscopic myomectomy under general anaesthesia were divided into two groups according to whether they had shoulder pain after surgery. Patient demographic data and duration of surgery, intraoperative blood loss volume, intraoperative carbon dioxide (CO2) usage volume, the usage of an abdominal drainage tube or not, the usage of patient-controlled intravenous analgesia (PCIA) or not were recorded. Statistical analyses were performed using SPSS. Data were compared using Student’s t-test or chi-square test. Risk factors were analyzed using logistic regression.ResultsThe incidence of shoulder pain was 43.18%. The body mass index (BMI) of the shoulder pain group was significantly lower than that of the non-shoulder pain group (OR = 0.629, p < 0.05). Patients with BMI < 21.64 are more likely to experience postoperative shoulder pain. The use rate of abdominal drainage tubes was higher in the non-shoulder pain group (OR = 0.509, p < 0.05).ConclusionPLSP is more likely to occur in patients with lower BMI (<21.64), and placing an abdominal drainage tube can reduce the occurrence of shoulder pain.

This study aims to explore the efficacy and safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES), laparoscopy, and robot-assisted laparoscopic myomectomy (RALM) for uterine fibroid removal. Computer searches were conducted in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and other databases until May 2023. Randomized controlled trials, cohort studies, case-control studies, and other relevant studies comparing the safety and efficacy of vNOTES, laparoscopy, and RALM for uterine fibroid treatment were included. A total of 28 studies involving 3247 subjects were included. Fifteen studies compared laparoscopy and RALM, thirteen studies compared laparoscopy and vNOTES, and there were no direct comparisons between RALM and vNOTES. In terms of surgical time, vNOTES had significantly shorter surgical time than laparoscopy (MD = 29, 95% CI: 0.89-47) and RALM (MD = 60, 95% CI: 30-90). RALM had significantly shorter surgical time than laparoscopy (MD = -33, 95% CI: -56, -92). There was no significant difference in intraoperative blood loss among the three treatment methods. Regarding hospital stay, vNOTES had a significantly shorter duration than laparoscopy (MD = 0.59, 95% CI: 0.32-0.89) and RALM (MD = 0.51, 95% CI: 0.027-1.00). Laparoscopy had a significantly higher laparotomy rate than vNOTES (OR = 0.27, 95% CI: 0.64-8.4). The rate of postoperative complications was significantly higher in laparoscopy compared to vNOTES (OR = 0.54, 95% CI: 0.23-1.0) and RALM (OR = 0.39, 95% CI: 0.17-0.92). In patients with uterine fibroids, vNOTES demonstrated significantly shorter surgical time, shorter hospital stay, lower laparotomy rate, and lower rate of postoperative complications compared to laparoscopy. However, vNOTES did not show significant advantages over RALM, except for shorter surgical time.

Robotic-assisted laparoscopy has expanded the surgical options for myomectomy, but its economic impact compared with laparotomy and conventional laparoscopy remains debated. We conducted a retrospective single-center study of 314 patients who underwent myomectomy between 2009 and 2019: 207 laparotomy, 78 robotic-assisted laparoscopy, and 29 conventional laparoscopy. Patients in the laparotomy group presented with significantly larger fibroids (mean weight 449g vs 175g in the robotic group, p < 0.001). Robotic procedures were associated with longer operative times (155 vs 98min for laparotomy, p < 0.001) but shorter hospital stays (3.7 vs 5.0days for laparotomy, p < 0.001). The hemoglobin drop was lower in the robotic group (1.2 vs 2.5g/dL, p < 0.001), and minor complications were less frequent (8% vs 25% after laparotomy). Compared with conventional laparoscopy, robotic surgery allowed resection of more complex interstitial fibroids, but at the expense of longer operating times (155 vs 100min for laparoscopy, p < 0.001). The mean global cost per procedure was €6,818 for robotic myomectomy, higher than laparotomy (€5,347) and laparoscopy (€5,188). Robotic myomectomy provides clinical advantages over laparotomy but remains associated with substantially higher costs.

Aim: to assess an impact of laparoscopic superior hypogastric plexus (SHP) block combined with preemptive troacar site infiltration on postoperative pain intensity following laparoscopic myomectomy. Materials and Methods . The prospective randomized placebo-controlled double-blind clinical trial enrolled 207 patients undergoing laparoscopic myomectomy. Patients randomized into 3 groups with a target ratio of 1:1:1 were included in the study gradually, some (n = 9) were excluded from the study intraoperatively. Thus, the study included 198 patients: group 1 (n = 66) received standard systemic analgesia combined with troacar site infiltration and laparoscopic SHP block; group 2 (n = 65) received troacar site infiltration without SHP block; control group (group 3, n = 67) received standard systemic analgesia alone. The primary endpoint was presented by assessing pain intensity using the numeric rating scale (NRS) at 4 hours postoperatively. Secondary endpoints included NRS dynamics at 2, 6, 8, 12, and 24 hours postoperatively, time to first mobilization, opioid use, and pain quality assessment. Results . Pain scores were significantly lower in the combined analgesia group (group 1) at all time points assessed up to 12 hours postoperatively and at discharge (p &lt; 0.05). Opioid use in group 1 was also markedly reduced (4.5 %) compared to control group 3 (32.8 %; p = 0.001). Time to first mobilization was significantly shorter in group 1 compared to group 2 and group 3 (median 5 hours vs. 7 hours; p = 0.017). Deep pelvic (visceral) pain was more commonly reported in group 2 and group 3 than in group 1 (p = 0.021). Conclusion . Preemptive multimodal analgesia combining troacar site infiltration with laparoscopic SHP block provides effective postoperative pain control, reduces opioid intake, and accelerates postoperative mobilization following laparoscopic myomectomy. This approach offers a promising strategy for improving recovery and minimizing opioid use in fertility-preserving gynecologic surgery.

To evaluate early recovery outcomes with transcervical fibroid ablation (TFA) compared to minimally invasive myomectomy (MIM) in women with symptomatic uterine fibroids. Randomised controlled trial. Tübingen University Hospital (Tübingen, Germany). Premenopausal women aged 18-50 years with symptomatic uterine fibroids. Participants were randomised to undergo TFA or MIM. The MIM group underwent laparoscopic myomectomy with concurrent hysteroscopic myomectomy if submucosal fibroids were present. The primary endpoint was the time to return to normal activities. Secondary outcomes included procedure time, postprocedural pain, hospital discharge readiness, time to return to 10 additional activities of daily living, and adverse events. Clinical outcomes through 7 weeks of follow-up were reported. The primary endpoint was evaluated at p < 0.028 due to a pre-planned interim analysis; secondary outcomes were evaluated at p < 0.05. Among 144 randomised patients, 119 provided follow-up data (58 TFA; 61 MIM). The primary endpoint was met with the median time to return to normal activities favouring TFA (5.5 vs. 13 days; log-rank p < 0.001). Procedure time (51 ± 21 vs. 95 ± 37 min; p < 0.001), postprocedural pain through discharge (all p < 0.01), opioid utilisation (25.9% vs. 49.2%, p = 0.009), and time to discharge readiness (22.9 ± 13.2 vs. 58.9 ± 33.1 h; p < 0.001) favoured TFA. Nine of 10 treatment recovery metrics statistically favoured TFA with none favouring MIM. One serious adverse event occurred in a patient treated with MIM (diagnostic laparoscopy for postoperative bleeding). TFA offers a faster recovery than MIM for the treatment of symptomatic uterine fibroids, with a comparable short-term safety profile. This trial was prospectively registered on the German Clinical Trials Register; https://drks.de/search/de/trial/DRKS00028847.