Laparoscopic Myomectomy Research Articles

Case Report: A Case of Mitotically Active Cellular Fibroma of the Ovary Misdiagnosed Preoperatively as Pedunculated Subserosal Uterine Leimyoma

Cellular fibroma is the most common benign tumor of the ovary characterized by cellularity. Mitotically active cellular fibroma is a subtype of cellular fibroma showing mitotic activity, but no nuclear polymorphism or necrosis. These tumors are often misdiagnosed preoperatively as uterine myomas. A 42-year-old woman presented with pain in the right groin. Transvaginal ultrasound revealed a normal left ovary and a semisolid mass of approximately 4.5 x 5 cm originated from the right ovary. Pelvic MRI was reported as subserosal pedunculated uterine leiomyoma in the close antero-superior, right lateral proximity with the uterus fundus and the patient was scheduled for laparoscopic myomectomy. The excised mass was sent for the pathological examination, which resulted in the confirmed diagnosis of mitotically active cellular fibroma. The patient was informed about the local recurrence potential of cellular fibromas and frequent control visits were scheduled before the patient was discharged.

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation.

The authors reviewed uterine fibroid (UF) morcellation and its potential consequences, notably a hypothetical spread and dissemination of occult uterine leiomyosarcoma (LMS) tissue, evaluating the effect of laparoscopic versus open myomectomies with and without morcellation on patients’ outcomes, as well as related medical-legal issues. MEDLINE and PubMed search was performed for the years 1990–2021, using a combination of keywords on this topic. Relevant articles were identified and included in this narrative review. There is an individual risk, for all patients, for LMS diagnosis after myomectomy. However, the risk for occult LMS diagnosis during a laparoscopic myomectomy is generally reduced when the guidelines of scientific societies are followed, with an overall benefit from the laparoscopic approach with morcellation in appropriate cases. Gynecological societies do not ban morcellation and laparoscopic hysterectomy/myomectomy per se, but recommend their use on the basis of the patients’ clinical characteristics. It is suggested for gynecologists to provide detailed information to patients when obtaining an informed consent for open or laparoscopic hysterectomy/myomectomy. A detailed preoperative assessment of patients and the risk benefit ratio of laparoscopic morcellation of uterine mass could overcome the “a priori” banning of the morcellation technique.

MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma: A Consensus Statement.

Laparoscopic myomectomy, a common gynecologic operation in premenopausal women, has become heavily regulated since 2014 following the dissemination of unsuspected uterine leiomyosarcoma (LMS) throughout the pelvis of a physician treated for symptomatic leiomyoma. Research since that time suggests a higher prevalence than previously suspected of uterine LMS in resected masses presumed to represent leiomyoma, as high as one in 770 women (0.13%). Though rare, the dissemination of an aggressive malignant neoplasm due to noncontained electromechanical morcellation in laparoscopic myomectomy is a devastating outcome. Gynecologic surgeons' desire for an evidence-based, noninvasive evaluation for LMS is driven by a clear need to avoid such harms while maintaining the availability of minimally invasive surgery for symptomatic leiomyoma. Laparoscopic gynecologists could rely upon the distinction of higher-risk uterine masses preoperatively to plan oncologic surgery (ie, potential hysterectomy) for patients with elevated risk for LMS and, conversely, to safely offer women with no or minimal indicators of elevated risk the fertility-preserving laparoscopic myomectomy. MRI evaluation for LMS may potentially serve this purpose in symptomatic women with leiomyomas. This evidence review and consensus statement defines imaging and disease-related terms to allow more uniform and reliable interpretation and identifies the highest priorities for future research on LMS evaluation.

Gynaecological Laparoscopic Surgeries in the Omicron Era: Improvising the Management Skills After Lessons Learnt From the Delta Wave.

Background During the peak of the Omicron wave, elective laparoscopic surgeries were restricted; however, semi-emergency and emergency cases were managed despite the limited resources and manpower. We conducted this study to assess the types of gynaecological laparoscopic surgeries performed, the difficulties faced during the Omicron wave, and how we could implement the lessons learnt from the previous Delta wave for better management of gynaecological cases in the Omicron wave. Methodology We conducted a prospective cohort study over a period of three months involving 105 patients who underwent laparoscopic surgeries. Based on the decision regarding surgical incision time, the surgeries were sub-classified into immediate, urgent, and expedited. The surgical outcome and satisfaction rates among the patients were assessed through various parameters. Results Most of the women (81.9%) were pre-menopausal. Diabetes and chronic hypertension were the predominant medical co-morbidities. Three patients had a history of cardiac valve replacement which required switching warfarin to unfractionated heparin in the pre-operative period. Nearly three-fourthsof the study patients were doubly vaccinated against coronavirus disease 2019 (COVID-19) (77; 73.4%). A total of 14 (13.3%) patients had a history of COVID-19 infection in the past two weeks prior to the current admission. Immediate, urgent, and expedited surgeries comprised 11.4%, 22.8%, and 65.8% of total surgeries, respectively. On assessing the ease of pre-operative preparation according to the five-point Likert scale, immediate, urgent, and expedited surgeries were rated with a mean score of two, four, and five, respectively. The mean duration of surgery in the immediate and urgent groups was 37.6 and 44.2 minutes, respectively. The expedited group comprising mostly laparoscopic myomectomies and hysterectomies required an average duration of 92.6 minutes. The mean rating of patient satisfaction measured by the Likert scale was four, five, and five, respectively, in the three subgroups. Pre-operative patient preparation during the Omicron wave was faster, thereby decreasing the decision to incision interval compared to the Delta wave. Conclusions Thelessons learnt from the previous Delta wave were used to modify the existing hospital policies in the Omicron wave. More number of vaccinated ground staff, less stringent intubation and extubation protocols during surgery, and lesser duration of post-operative stay helped modify our existing hospital policies for better patient care and satisfaction.

RACIAL DISPARITIES IN ABDOMINAL AND LAPAROSCOPIC MYOMECTOMIES

To investigate ethnic and racial disparities among outcomes of abdominal and laparoscopic myomectomies.

HYSTEROSCOPIC MYOMECTOMY IS NOT ASSOCIATED WITH INTRAPERITONEAL DISSEMINATION OF MYOMETRIAL CELLS

Hysteroscopic myomectomy is the surgical treatment of choice for women with submucosal fibroids. Although many studies have looked at the risk of intraperitoneal dissemination of myoma cells following laparoscopic myomectomy, only a few isolated case reports have shown the possible spread of leiomyosarcoma cells intraperitoneally following hysteroscopic myomectomy. The objective of this study is to determine whether myometrial cells can be detected intraperitoneally following hysteroscopic myomectomy.

The “Trick” Knot—A Modified Technique of the Removable “Shoelace” Knot for Temporary Ligation of the Uterine Artery at Its Origin

To demonstrate the "trick" knot, a technique of temporary ligation of the uterine artery at origin, a modification of the previously published "shoelace" knot. A video demonstration. A private hospital. Bilateral uterine arteries at origin are exposed after dissection of the peritoneum over the triangle formed by the round ligament, the infundibulopelvic ligament, and the pelvic sidewall [Video 1]. A 60-cm long free polyglactin absorbable suture with preformed knots at each end is introduced around the skeletonized uterine artery. Using a single throw, the "trick" knot is made by pulling out a loop of thread. The end is cut short, and the same suture is used to similarly ligate the other uterine artery. Each knot thus formed has a free end and a knotted end. Laparoscopic myomectomy is performed. On completion of the procedure, the knot is released by pulling the free end, restoring the blood supply to the uterus. Bilateral uterine artery ligation, although an effective method to curb bleeding during a laparoscopic myomectomy, when performed permanently, may lead to undesirable outcomes in women who wish to preserve fertility [1-3]. Methods for temporary ligation of the uterine artery at origin, such the removable vascular clips, are thus regarded justifiable [4]. In contrast to the removable "shoelace" knot, which uses a loop to make a throw, the technique of performing the "trick" knot mimics the steps of forming a regular intracorporeal knot [5]. This makes the latter technically easier and hence faster to perform, while still being as economic and reproducible as the former.

Successful laparoscopic management of acute abdominal pain due to spontaneous rupture of subserosal vessels overlying a uterine fibroid: a case report and surgical video

BackgroundAcute abdomen comprises several emergencies. Hemoperitoneum associated with uterine fibroids, which can present as acute abdominal pain, is rare and difficult to diagnose. Especially, spontaneous hemorrhage from the rupture of the superficial vessels overlying a uterine fibroid is extremely rare, and its diagnosis and management have not been established.Case presentationWe report a case of a 55-year-old woman who presented at our hospital with acute abdomen. After performing a computed tomography scan, we conducted a laparoscopic examination and diagnosed hemoperitoneum of ambiguous origin. We treated the patient surgically, performing a laparoscopic myomectomy to remove the origin of the hemorrhage. The patient recovered well.ConclusionsWe report a case of hemoperitoneum of ambiguous origin that was diagnosed laparoscopically and treated by laparoscopic myomectomy to remove the origin of the hemorrhage. Surgeons should rapidly diagnose and manage acute abdominal pain in women with a history of uterine fibroids to prevent severe morbidity or even mortality. Therefore, laparoscopic surgery is recommended in patients with stable hemodynamics.

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids.

Background Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results The postoperative exhaust time (13.14 ± 2.03) h, bed time (9.86 ± 1.94) h, postoperative hospital stay (4.37 ± 1.31) d, and total hospital stay (6.78 ± 1.69) d in the B group were shorter than those in the A group, and the hospitalization expenses (0.74 ± 0.25) million were less than those in the A group (P < 0.05). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups (P > 0.05). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1β (IL-1β) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group (P < 0.05). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group (P < 0.05). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention (P > 0.05). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group (P < 0.05). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group (P < 0.05). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant (P > 0.05). Conclusion Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.

A CLINICAL CASE OF ABDOMINAL MORCELLOMAS

Aim of the study is to present a clinical case of abdominal morcellomas.Methods: The technique of morcellation involves not only incisions, but also a significant crushing of tumor cells, which can eventually lead to the spread of the disease. Fibroids left in the abdominal cavity during morcellation continue their development and can reach tumors of considerable size. An observation of the detected parasitic uterine fibroids several years after laparoscopic myomectomy is presented.Result: Histological examination of the removed preparation shows a microscopic picture of the uterine leiomyoma node of a typical structure in a thin fibrous capsule. It was received a normal postoperative course and a patient was discharged from hospital on the 4th day.Conclusion: Abdominal morcellomas after laparoscopic interventions on the uterus is a rare complication associated with the parasitic persistence of myomatous tissue on the abdominal organs. The risks of such complications of endosurgery indicate the need for strict compliance with all technical aspects of using a devices for the evacuation of removed tissues, careful intraoperative monitoring and sanitation of the abdominal cavity.

Outcomes of In-bag Transvaginal Extraction in a Series of 692 Laparoscopic Myomectomies: Results from a Large Retrospective Analysis

Transvaginal extraction is feasible method to remove surgical specimen. In this study, we aim to report our experience with in-bag transvaginal specimen retrieval after laparoscopic myomectomy over the last 15 years. Single-center retrospective analysis. Academic hospital. Women who underwent laparoscopic myomectomy from January 2005 to April 2021. Posterior colpotomy and in-bag transvaginal extraction of the surgical specimen. We collected and analyzed data about patients' characteristics, main indication for surgery, intra- and post-operative (within 30 days) complications. A total of 692 women underwent transvaginal specimen retrieval after laparoscopic myomectomy (mean largest myoma diameter: 6.64 ± 2.21 cm; mean specimen weight: 177 ± 140 grams; mean operative time: 84.1 ± 37.1 minutes; mean blood loss: 195 ± 191 ml). Within 30-days, we reported the following colpotomy-related complications: 4 (0.6%) cases of vaginal bleeding, which resolved spontaneously in 3 cases (one case required readmission with new colporrhaphy under general anesthesia); 2 (0.3%) cases of vaginal pain, with no underlying cause identified on physical examination and pelvic ultrasound. Specimen weight was positively correlated with longer operative time, intraoperative blood loss and length of hospital stay. Posterior colpotomy and in-bag transvaginal extraction can be considered a feasible option for retrieval of surgical specimens after laparoscopic myomectomy.

The effects of morning/afternoon surgeries on the early postoperative sleep quality of patients undergoing general anesthesia

ObjectiveThis study aimed to investigate the effects of morning and afternoon surgeries on the early postoperative sleep function in patients undergoing general anesthesia.MethodsFifty nine patients, aged 18–60 years, American society of anaesthesiologists (ASA) grade I or II, Body mass index of 18.5–28 kg/m2, undergoing laparoscopic myomectomy under total intravenous anesthesia, were included in the study. These patients were divided into two groups according to the start time of anesthesia: morning surgery group (group A, 8:00–12:00) and afternoon surgery group (group P, 14:00–18:00). The sleep conditions of the two groups of patients were evaluated by the Athens Insomnia Scale (AIS) one day before and one day after the operation. A total score of > 6 was regarded as postoperative sleep disturbance. The incidences of sleep disturbance one day after the operation in two groups were compared. The bispectral Index assessed the patient’s total sleep duration, sleep efficiency, and overall quality of sleep from 21:00 to 6:00 on the first night after surgery. Plasma concentrations of melatonin and cortisol at 6:00 am 1 day before surgery, 1 day after surgery were measured by ELISA, and rapid random blood glucose was measured.ResultsThe total AIS score, overall quality of sleep, total sleep duration, and final awakening earlier than desired scores of the two groups of patients on the first night after surgery were significantly increased compared with preoperative scores (P < 0.01). In group P, the sleep induction and the physical and mental functioning during the day scores increased significantly after surgery compared with preoperative scores (P < 0.05). The postoperative AIS scores in group P increased significantly compared with those in group A (P < 0.01). The incidence of postoperative sleep disturbances (70.0%) in group P was significantly higher than that in group A (37.9%) (P < 0.05). Compared with group A, the total sleep duration under BIS monitoring in group P was significantly shorter, the sleep efficiency and the overall quality of sleep was significantly reduced (P < 0.01). Compared with those in group A, the level of melatonin on 1 d after surgery in group P was significantly decreased, and the level of cortisol in group P was significantly increased. There were no significant differences between the two groups in the levels of postoperative blood glucose and pain.ConclusionBoth morning and afternoon surgeries have significant impacts on the sleep function in patients undergoing general anesthesia, while afternoon surgery has a more serious impact on sleep function.Trial registrationClinicalTrials, NCT04103528. Registered 24 September 2019—Retrospectively registered, http://www.ClinicalTrials.gov/ NCT04103528.

Unscarred and Scarred Uterine Rupture in Pregnancy: A Six-case Series in Taipei Tzu-Chi Hospital

&lt;p&gt;Objectives: This study included six uterine rupture in pregnancy cases over 12 years at Taipei Buddhist Tzu-Chi Hospital. We describe the clinical features and outcomes of rupture of unscarred uteri and scarred uteri following laparoscopic myomectomy. Materials and methods: This case series was conducted by reviewing medical charts at Taipei Tzu-Chi Hospital from May 2005 to October 2017. Of 22,962 women who gave birth, six women with full-thickness disruption of all uterine layers during pregnancy or delivery were enrolled. Results: Three cases had ruptures of unscarred uteri and three cases had in uteri scarring by previous laparoscopic myomectomy. The overall incidence of uterine rupture was 0.026%. In women with scarred uteri, the risk of uterine rupture was 0.21%. All uterine ruptures occurred after gestation for 34 weeks although ruptures occurred slightly earlier in the scarred group. All cases received hysterorrhaphy. One neonatal death occurred in the unscarred group and one intrauterine fetal death was diagnosed at admission in the scarred group. Conclusion: Although uterine rupture is a rare complication, the risk is higher for uteri scarred by cesarean section, abdominal myomectomy, or laparoscopic myomectomy. Comparison of risk after abdominal and laparoscopic surgery remains a topic of debate. Regardless of the transmyometrial surgical approach, surgeons should limit electrosurgery and perform multilayer closure. Additionally, early detection and management not only improves maternal and fetal outcomes, but also preserves patient fertility.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Effect and safety of diluted vasopressin injection on bleeding during robot-assisted laparoscopic myomectomy: a protocol for a randomised controlled pilot trial

IntroductionEven though the injection of diluted vasopressin into the uterus is expected to reduce intraoperative bleeding with decreased adverse effects during robot-assisted laparoscopic myomectomy (RALM), there is a lack of...

Analysis of Clinical Value of Laparoscopic Myomectomy Via Single Umbilical Hole in the Treatment of Hysteromyoma

Analysis of Clinical Value of Laparoscopic Myomectomy Via Single Umbilical Hole in the Treatment of Hysteromyoma

Laparoscopic myomectomy using barbed or conventional sutures

To assess the differences in surgical outcomes between bidirectional barbed suture and conventional suture for myoma bed closure during laparoscopic myomectomy. Study design: Ninety-two patients with one to three symptomatic myomas were randomized in a 1:1 ratio to the barbed suture group or the conventional suture group. Myoma bed was sutured either with barbed suture (STRATAFIX™, Ethicon Inc, USA) or continuous conventional suture with intracorporeal knot tying (Vicryl; Ethicon, USA). The surgeon assessed the degree of suturing difficulty using a visual analog scale ranging from 1 (least difficult suturing) to 10 (most difficult suturing). Results: Suturing with barbed suture was easier than suturing with conventional suture (3.04±1.47 Vs. 4.75± 1.35, P &lt; 0.001). Suturing time of the myoma bed was significantly shorter in the barbed suture group (14.98±4.81 Vs 22.09±6.9 min; P &lt; 0.001). Operative time was comparable between both groups (69.67±17.63 Vs 74.15±19.79 min; P = 0.255). The mean intraoperative blood loss was significantly higher in conventional suture group (337.24±234.15 ml Vs 211.3±107.62; P= 0.002). Conclusion: The barbed suture facilitates suturing of the myoma bed during laparoscopic myomectomy. Compared with conventional suture, barbed suture reduces the time needed to suture the myoma bed and the intraoperative blood loss.&#x0D;

The Comparison of Life Quality between Ultrasound-Guided High-Intensity Focused Ultrasound and Laparoscopic Myomectomy for the Treatment of Uterine Fibroids.

Objective This study is aimed at comparing the uterine fibroids patients' postoperative living quality between ultrasound-guided high-intensity focused ultrasound (HIFU) and laparoscopic myomectomy. Materials and Methods A total of 164 patients were included with uterine fibroids who underwent laparoscopic myomectomy and HIFU in Cangzhou Central Hospital from September 2020 to November 2021. This study divided these objects into HIFU group and laparoscopic group, and both groups were followed up 6 months after surgery. After obtaining the results, Uterine Fibroid Symptom and health-related Quality Of Life questionnaire (UFS-QOL) and 36-Item Short Form Health Survey (SF-36) were performed before and after treatment to assess patient outcome. Results After treatments, the living quality in both groups was significantly improved compared with that before surgery, which had statistical significant (P < 0.05). After treatment, the scores of the two scales in HIFU group were significantly better than those in the laparoscopic group (P < 0.05). Conclusion In comparison with laparoscopic myomectomy, ultrasound-guided high-intensity focused ultrasound could improve the life quality of patients more effectively than traditional laparoscopic myomectomy and was helpful to the recovery and prognosis of uterine fibroids after treatment. The outcomes will provide a reference for clinicians to select a more appropriate treatment for uterine fibroids.

The effect of temporary uterine artery ligation on laparoscopic myomectomy to reduce intraoperative blood loss: A retrospective case-control study.

ObjectiveTo reduce intraoperative blood loss in laparoscopic myomectomy, uterine artery occlusion or temporary uterine artery clipping have been employed. Recently, in addition to these techniques, temporary uterine artery ligation has been reported as a new method that has less invasive effects on fertility and needs no special devices to be used. This study aimed to evaluate the effect of temporary uterine artery ligation to minimize intraoperative blood loss during laparoscopic myomectomy.Study DesignThis was a retrospective case-control study at the department of Obstetrics and Gynaecology, University Hospital Mizonokuchi, Teikyo University School of Medicine. A total of 264 patients with uterine leiomyoma who underwent laparoscopic myomectomy were enrolled in this study. We divided the patients into two groups, those who underwent temporary uterine artery ligation (52 patients) and those who did not (212 patients) and compared the operation time, blood loss volume, and other indexes. Second, to identify influential factors, we assessed the effects of 11 representative factors on massive blood loss or a prolonged operation time using multivariate analysis.ResultsThe intraoperative blood loss volume was decreased by approximately half with the addition of temporary uterine artery ligation (75.1 ± 73.6 ml vs. 158.5 ± 233.2 ml, p = 0.011), but the operation time was longer (200.5 ± 46.9 min vs. 160.1 ± 51.3 min, p < 0.001). Among the 264 patients, 25 patients (9/52 in the case group and 16/212 in the control group) had a prolonged operation time (≥ 240 min), and 24 patients (1/52 in the case group and 23/212 in the control group) experienced massive blood loss (≥ 400 ml). In the multivariate analysis, high body mass index, concomitant surgery and temporary uterine artery ligation showed a positive association with a prolonged operative time, and the presence of single leiomyoma showed a negative association. Concomitant surgery and the presence of large leiomyoma showed a positive association with massive blood loss, and temporary uterine artery ligation showed a negative association.ConclusionsBy performing temporary uterine artery ligation during laparoscopic myomectomy, the volume of intraoperative blood loss could be decreased, especially in patients with large leiomyomas. However, because this procedure prolongs the operation time, there is still room for improvement.

Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?

Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?

Clarification of issues brought up by 'Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?'.

Clarification of issues brought up by 'Is enhanced recovery after surgery protocol has high value in after laparoscopic myomectomy?'.