Laparoscopic Myomectomy Research Articles

Surgical impact of bilateral transient occlusion of uterine and utero-ovarian arteries during laparoscopic myomectomy

The objective of this article is to compare the amount of intraoperative blood loss during laparoscopic myomectomy when performing bilateral transient clamping of the uterine and utero-ovarian arteries versus no intervention. It´s a randomized controlled prospective study carried out in the Department of Obstetrics and Gynecology Ramón y Cajal University Hospital and HM Montepríncipe-Sanchinarro University Hospital, Madrid, Spain, in women with fibroid uterus undergoing laparoscopic myomectomy. Eighty women diagnosed with symptomatic fibroid uterus were randomly assigned to undergo laparoscopic myomectomy without additional intervention (Group A) or temporary clamping of bilateral uterine and utero-ovarian arteries prior to laparoscopic myomectomy (Group B). Estimated blood loss, operating time, length of hospital stay, and postoperative hemoglobin values were compared in both groups. The number of fibroids removed was similar in both groups (p = 0.77). Estimated blood loss was lower in the group of patients with prior occlusion of uterine arteries (p = 0.025) without increasing operating time (p = 0.17) nor length of stay (p = 0.17). No patient had either intra or postoperative complications. Only two patients (2.5%) required blood transfusion after surgery. We conclude that temporary clamping of bilateral uterine arteries prior to laparoscopic myomectomy is a safe intervention that reduces blood loss without increasing operative time.

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review.

The objective of this systematic review is to investigate the impact of laparoscopic myomectomy techniques on pregnancy outcomes, with a specific focus on the correlation between the type of suture used during the procedure and the incidence of uterine rupture. Additionally, the study aims to examine how the localization and size of myomas, key factors in laparoscopic myomectomy, may influence fertility outcomes. extensive searches were conducted using MDPI, PubMed, Web of Science, and Cochrane Library databases from 2008 to November 2023. The study involved women of reproductive age diagnosed with fibroids who underwent surgical removal of fibroids using either laparotomy or laparoscopy. The evaluation of pregnancy outcomes focused on indicators such as live birth rates, miscarriage rates, stillbirth rates, premature delivery rates, and cases of uterine rupture. Quality assessment was systematically performed by employing the National Institutes of Health Study Quality Assessment Tools, with the subsequent formulation of clinical recommendations that were meticulously graded in accordance with the robustness of the underlying evidence. The pregnancy outcomes post-myoma treatment, as reflected in one of the presented tables, show a promising number of pregnancies and live births, but also indicate the potential risks of miscarriages and preterm births. The diversity in outcomes observed among various studies underscores the imperative for tailored patient care, as well as the necessity for additional research aimed at optimizing fertility and pregnancy outcomes following myoma treatment. This study offers insights into the criteria for patient selection and intraoperative methodologies specifically related to laparoscopic myomectomy. To enhance our understanding of the associations between fibroid characteristics (location, size) and reproductive outcomes, additional research is warranted, particularly through well-designed clinical trials.

Evaluation of the Efficacy and Effectiveness of Hysteroscopic Electroresection in the Treatment of Submucosal Uterine Fibroids

Objective: To evaluate the effect of hysteroscopic electroresection in treating submucosal uterine fibroids. Methods: Using the random number table method, 70 patients with submucosal uterine fibroids were divided into two groups, 35 cases/group. The control group underwent laparoscopic myomectomy, and the observation group underwent hysteroscopic electroresection. Surgical indicators, sex hormone indicators, inflammation indicators, and treatment effects were compared between the two groups. Results: The surgical indicators, sex hormone indicators, and inflammatory indicators three months after operation in the observation group were all more ideal than those of the control group. The total effective rate of the observation group (97.14%) was higher than that of the control group (P < 0.05). Conclusion: Hysteroscopic electroresection for the treatment of submucosal uterine fibroids was less invasive, accelerates recovery, and is more effective.

Impact of trainees involvement on surgical outcomes of abdominal and laparoscopic myomectomy

Background To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications. Methods A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008–2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2). Results Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97], p < 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [−18.07,27.35], p = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%, p < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51], p < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%, p = 0.86; OR 0.82, 95% CI [0.16,4.14], p = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%, p < 0.01; OR 2.96, 95% CI [1.77,4.93], p < 0.01) and minor complications (14% vs 4%, p < 0.01; OR 3.71, 95% CI [2.09,6.57], p < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10% p = 0.41; OR 0.59, 95% CI [0.18,2.01], p = 0.40), major (2% vs 0%, p = 0.38), or minor (5% vs 10%, p = 0.32; OR 0.52, 95% CI [0.15,1.79], p = 0.30) complications. Conclusion Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy.

Laparoscopic myomectomy in a single centre over 10 years: a retrospective study

Laparoscopic myomectomy in a single centre over 10 years: a retrospective study

Abstract 5055: Genetic background of recurrent uterine leiomyomas

Abstract Uterine leiomyomas, also known as fibroids, are common benign smooth muscle tumors in women of reproductive age. Leiomyomas can cause symptoms that can significantly reduce the quality of life. Treatment mainly involves hysterectomy or myomectomy, the latter for women who wish to preserve their uterus. Most leiomyomas harbor one of the three driver mutations affecting either MED12, HMGA2, or FH. Recently identified rare subtypes include tumors with mutations in genes linked to the neddylation of the Cullin 3-RING E3 ligase or SRCAP complex. Recurrence of leiomyomas is poorly understood in relation to their clonal origins and molecular factors. The aim of this study was to characterize the mutational profiles of leiomyomas from recurrent operations and to identify the frequency of clonally related tumors. We utilized a retrospective cohort of 234 women who underwent laparoscopic or open abdominal myomectomy, with 46 (20%) of them experiencing multiple procedures related to leiomyomas. We examined the mutation profiles of 133 leiomyomas (62 index and 71 recurrent tumors) from 33 patients who required multiple tumor removal surgeries. We screened the tumors for the three primary leiomyoma drivers—MED12 mutations, HMGA2 overexpression, and FH-deficiency—to identify potentially clonal tumors. We found that 21 out of 33 (64%) patients had tumors from multiple operations with identical leiomyoma driver alterations. To further assess the clonal relationship, we executed whole exome sequencing on these 52 tumors. We identified three patients with two clonally related tumors each through shared somatic copy number alterations and point mutations. The clonally related tumors included HMGA2, FH, and wild-type tumors. Notably, leiomyomas with MED12 mutations—the most common molecular leiomyoma subtype—were not found among the clonally related tumors. Three patients harbored numerous FH-deficient tumors from recurrent operations. In all those patients, we found FH germline mutations, characteristic of Hereditary Leiomyomatosis and Renal Cell Cancer syndrome (HLRCC). Moreover, we identified somatic mutations in YEATS4, a member of the SRCAP complex, in four recurrent tumors from three patients. Interestingly, all YEATS4 mutations were different, and the tumors were not clonally related. Further research is required to elucidate the role of YEATS4 in leiomyoma recurrence. In conclusion, our systematic study confirms that reinterventions are common after myomectomy, and while uterine leiomyomas typically develop independently, some share a clonal origin. Additionally, we show that recurrence may be due to genetic predispositions, such as germline FH mutations. Citation Format: Sara Khamaiseh, Anna Äyräväinen, Maare Arffman, Siiri Reinikka, Annukka Pasanen, Ralf Bützow, Päivi Härkki, Pia Vahteristo. Genetic background of recurrent uterine leiomyomas [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5055.

Laparoscopic myomectomy videos on WebSurg and YouTube: does peer review process make a difference?

This study aimed to evaluate the quality of laparoscopic myomectomy videos on YouTube and WebSurg. We searched using the keyword "laparoscopic myomectomy" on WebSurg and selected surgical interventions in the gynecology section. Eleven videos on WebSurg were enrolled. We selected the 22 most-relevant videos on YouTube to create a comparison group, with a ratio of 1:2. Sound in videos, number of subscribers, views, likes, and comments, number of days since videos were uploaded and durations of videos were recorded. View/day, like/view, like/subscriber, and view/subscriber ratios were calculated. The videos were evaluated with usefulness score (US), global quality scoring (GQS), modified discern score (mDS) and laparoscopic surgery video educational guidelines (LAP-VEGaS). The view/day ratio was lower in WebSurg compared to YouTube [1.3 (1.9) vs. 7.5 (30.6), respectively; p=0.039]. No difference was found between WebSurg and YouTube in terms of US, GQS and mDS. On LAP-VEGaS assessment, WebSurg was found to be superior to YouTube in terms of intraoperative findings [2 (1-2) vs. 1 (0-2), p=0.001], additional materials [1 (0-2) vs. 1 (0-1), p=0.041], audio/written commentary [2 (2-2) vs. 2 (0-2), p=0.037], image quality [2 (2-2) vs. 2 (0-2), p=0.023], questions and total score [12 (11-13) vs. 10.5 (4-13), p=0.006]. The proportion of high-quality video was higher in WebSurg compared to YouTube, when the cut-off value of total score of 11 or 12 was used as 10 (100%) vs. 10 (50%), p=0.011 and 9 (90%) vs. 5 (25%), p=0.001, respectively. WebSurg was better compared to YouTube in terms of quality of laparoscopic myomectomy videos.

Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology.

Laparoscopic surgery is extensively utilized to treat a range of gynaecological conditions and pathologies. The advantages of laparoscopic surgery include the minimalization of blood loss and scarring, improved recovery times, and shorter hospital admissions. However, robotic technologies have had an increasing presence within gynaecological laparoscopic surgery in recent decades. This literature review therefore aims to discuss laparoscopy from 3 perspectives. First, the evolution of laparoscopy is reviewed with a focus on its origins, its transition from a diagnostic to an operative tool, and its role in present-day gynaecology. Second, interventions for benign gynaecological conditions (including excision of benign ovarian tumours, total laparoscopic hysterectomy, and laparoscopic myomectomy) are reviewed. The laparoscopic management of malignant gynaecology (including ovarian cancer, endometrial cancer, and cervical cancer) is also discussed. Finally, whilst robot-assisted laparoscopic surgery is experiencing rapid technological advancement, it is pertinent to consider the extent of its benefits when compared to open or conventional laparoscopic approaches in gynaecological surgery.

Determination of Whole Blood Loss From Minimally Invasive Myomectomy Using a Standardized Formula: A Pilot Study

Study ObjectiveTo determine the median perioperative blood loss (PBL) during minimally invasive surgical (MIS) myomectomy. DesignProspective pilot study. SettingLarge academic teaching hospital. PatientsThirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging. InterventionsA CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit − postoperative hematocrit)/preoperative hematocrit. Measurements and Main ResultsMedian PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion. ConclusionCalculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.

Laparoscopic continuous seromuscular circumsuture for myomectomy: a real-world, retrospective, East-Asian cohort study

ObjectiveThis study aimed to introduce a novel laparoscopic haemostasis for myomectomy and investigate the independent risk factors for uterine fibroid recurrence.DesignA retrospective cohort study.SettingFollowing strengthening the reporting of observational studies...

Risk of Placenta Accreta Spectrum Following Myomectomy: A Nationwide Cohort Study

ABSTRACT Placenta accreta spectrum (PAS) is described as a partial or total lack of decidua with adherence or invasion of the placenta to the myometrium and is a major cause of postpartum hemorrhage and peripartum hysterectomy. The risk of PAS is approximately 1 in 272 in the United States. Prior uterine surgeries including myomectomy disrupt the integrity of the endometrium and myometrium and may increase the risk of PAS. However, the association between myomectomy and PAS remains controversial. This retrospective nationwide cohort study aimed to investigate the effect of myomectomy, stratified by method of myomectomy, on the risk of PAS. Data were obtained from the Taiwan National Health Insurance Research Database, which includes prenatal, perinatal, demographic, and treatment data on nearly all pregnant patients in Taiwan. All pregnant people who gave birth after 20 weeks of gestation between January 2008 and December 2017 were included. Patients with incomplete data, previous history of PAS before myomectomy, robotic-assisted myomectomy, or a diagnosis of adenomyosis were excluded. Patients were classified into 3 groups according to method of myomectomy: laparotomic, laparoscopic, and hysteroscopic. A 1:1 propensity-score estimation matching with logistic regression was used for patients with and without history of myomectomy to minimize selection bias. The primary outcome was placenta accreta, whereas secondary outcomes included placenta previa, postpartum hemorrhage, placenta abruption, uterine rupture, and preterm delivery. Logistic regression models were used to analyze the association between myomectomy and adverse pregnancy outcomes and the risk of placenta accreta for the entire population. Analysis of variance and post hoc tests were used to analyze differences in clinical characteristics and adverse pregnancy outcomes according to different methods of myomectomy. A total of 1,393,628 patients were included in this study. Among them, 11,255 patients had a history of myomectomy. Placenta accreta spectrum occurred in 0.96% of those with a history of myomectomy and 0.20% of those without. The risk of PAS was significantly higher in patients with a history of myomectomy, compared with those without (adjusted odds ratio, 2.28; confidence interval [CI], 1.85–2.81; P &lt; 0.01). There was an elevated risk of other adverse pregnancy outcomes including placenta previa, postpartum hemorrhage, cesarean hysterectomy, uterine rupture, preterm delivery, and placenta abruption among those with a history of myomectomy compared with those without. The presence of placenta previa significantly increased risk of PAS, as did the number of prior myomectomies. The propensity score–matched cohort analysis found a similar increase in PAS risk associated with myomectomy. Compared with subjects without a history of myomectomy, the risk of PAS was greater after hysteroscopic (adjusted odds ratio, 3.88; 95% CI, 2.68–5.63), laparoscopic (2.02; 95% CI, 2.79–5.62), and laparotomic myomectomy (1.86; 95% CI, 1.33–2.60). The results of this study find that a history of myomectomy is significantly associated with increased risk of PAS in subsequent pregnancies. Hysteroscopic myomectomy was associated with the highest risk of PAS, and the presence of placenta previa or history of multiple myomectomies further increased the risk.

Surgical Treatment of Uterine Leiomyomas from 2016-2022 in the Republic of Kazakhstan

Background: Due to the transition to a mandatory health insurance system (MHIS) and also taking into account the impact of the COVID-19 pandemic, the purpose of this study was to evaluate the surgical treatment of uterine leiomyoma in Kazakhstan in recent years, taking into account the ratio of uterine-preserving surgery (UPS) and hysterectomy. Methods and Results: This epidemiological study was carried out upon the request of the Republican E-Health Center (RCEZ) to assess the dynamics of surgical treatment of uterine leiomyomas (UL) in Almaty at the expense of the Republican budget from 2016 to 2022. Since 2016, by 2022 there was a decrease in the total number of treated cases of UL at the expense of the Republican budget (from 1,478 to 1,063). From 2016 to 2019, there were statistically significantly more hysterectomies, whereas from 2020 to 2022 the number of uterine-preserving surgeries increased statistically significantly. The number of laparoscopic myomectomy and hysteroscopic myomectomy for treating submucous leiomyomas increased statistically significantly from 2016 to 2019. However, there were no statistical differences in the number of treated cases with this technique from 2020 to 2022. Conclusion: Although high-tech fibroid surgery has been performed more frequently in recent years, these numbers are insufficient today, which justifies the need to train more specialists in advanced technologies.

Myomectomy with ArtiSential fully articulating laparoscopic instruments: A prospective multicenter study.

ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°-unrestricted movement of the wrist joint, as in robotic surgery. The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy.

ENDOMETRIOSIS AND FERTILITY -NATURAL CONCEPTION FOLLOWING MULTIPLE SURGERIES FOR ENDOMETRIOSIS

The association between endometriosis and infertility is well established and treatment is challenging. It is a chronic and debilitating disease with multiple pathophysiologic mechanisms. Treatment involves both surgical/medical interventions and ART for those with infertility.&#x0D; Evidence on the ideal approach is inadequate and guidelines vary. The patient’s symptomatology, age, fertility desires and prior surgical interventions are important factors to consider. Fertility preservation is paramount.&#x0D; We present an interesting case of a nulliparous patient who over four years has had recurrent ovarian endometriosis, underwent four laparoscopic surgical/medical interventions, and ultimately achieved a natural conception.&#x0D; Case&#x0D; A 32-year-old female presented in 2019 with symptoms of endometriosis confirmed on pelvic ultrasound. Laparoscopy, the gold standard was performed and the histology confirmed endometriosis. Postoperatively, she was on medical management to control symptoms. However, seven months later, she presented with worsening symptoms despite being on Leuprolide and later Visanne. Ultrasound showed recurrent ovarian endometriosis and uterine fibroids. A Laparoscopic myomectomy, adhesiolysis, and excision of ovarian endometriosis were done. She was then on Visanne but 6 months later her symptoms returned. A scan showed recurrent left ovarian endometriosis and she underwent laparoscopic excision. Her symptoms improved. Two years later she presented with worsening symptoms. A repeat ultrasound scan showed ovarian endometriosis. With a desire to conceive, laparoscopic excision of endometriosis, Adhesiolysis, and chromopertubation were performed. She conceived spontaneously four months later and is currently in her second trimester. &#x0D; &#x0D; Conclusion&#x0D; Treatment for endometriosis is an enigma and has to be individualized. Shared decision-making is important and repeated surgical/medical interventions with fertility preservation are a plausible approach for those keen on child-bearing.

Characteristics associated with blood transfusion among women undergoing laparoscopic myomectomy: a National Surgical Quality Improvement Program study

Uterine fibroids are the most common benign tumors that affect females. A laparoscopic myomectomy is the standard surgical treatment for most women who wish to retain their uterus. The most common complication of a myomectomy is excessive bleeding. However, risk factors for hemorrhage during a laparoscopic myomectomy are not well studied and no risk stratification tool specific for identifying the need for a blood transfusion during a laparoscopic myomectomy currently exists in the literature. This study aimed to identify risk factors for intraoperative and postoperative blood transfusion during laparoscopic myomectomies and to develop a risk stratification tool to determine the risk for requiring a blood transfusion. This was a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Women who underwent a laparoscopic (conventional or robotic) myomectomy were included. Women who received 1 or more blood transfusions within 72 hours after the start time of a laparoscopic myomectomy were compared with those who did not require a blood transfusion. A multivariable analysis was performed to identify risk factors independently associated with the risk for transfusion. Two risk stratification tools to determine the need for a blood transfusion were developed based on the multivariable results, namely (1) based on preoperative factors and (2) based on preoperative and intraoperative factors. During the study period, 11,498 women underwent a laparoscopic myomectomy. Of these, 331(2.9%) required a transfusion. In a multivariable regression analysis of the preoperative factors, Black or African American and Asian races, Hispanic ethnicity, bleeding disorders, American Society of Anesthesiologists class III or IV classification, and a preoperative hematocrit value ≤35.0% were independently associated with the risk for transfusion. Identified intraoperative factors included specimen weight >250 g or ≥5 intramural myomas and an operation time of ≥197 minutes. A risk stratification tool was developed in which points are assigned based on the identified risk factors. The mean probability of transfusion can be calculated based on the sum of the points. We identified preoperative and intraoperative independent risk factors for a blood transfusion among women who underwent a laparoscopic myomectomy. A risk stratification tool to determine the risk for requiring a blood transfusion was developed based on the identified risk factors. Further studies are needed to validate this tool.

A practical approach to laparoscopic myomectomy for large uterine leiomyoma – a case report

Advancements in minimally invasive surgery have allowed uterine myomectomy to be performed laparoscopically with several well-established advantages. However, contention exists regarding the practicality of the laparoscopic approach for large uterine leiomyomas. As a result, many gynaecologists still prefer open surgery. Notwithstanding, several measures exist to combat the technical challenges of the procedure. These include manipulating port placement, the use of a laparoscopic tourniquet, and alternatives to laparoscopic power morcellation. Herein, we report a successful laparoscopic myomectomy performed in a nulliparous 33-year-old woman with a large symptomatic subserosal leiomyoma. In addition, we outline the steps and modifications to a standard laparoscopic myomectomy to facilitate the removal of a large uterine leiomyoma.

A study of incidence of fibroid uterus, symptomatology, and therapeutic outcome of different procedures in patients with fibroid uterus

Abstract Background: Fibroids are benign, monoclonal tumors of smooth muscle cells of myometrium. Due to wide spectrum of clinical symptoms, they represent tremendous public health burden on women and economic costs to society. Strategies are needed to prevent its formation to limit growth and to treat nonsurgically. Objective: The objective of the study was to study the incidence of fibroid uterus, symptomatology, and therapeutic outcome of different procedures in fibroid uterus. Materials and Methods: Hospital-based prospective study was carried out among 14,250 patients. Among them, 3277 patients had fibroid uterus and 100 cases were included. Diagnosis was made by clinical examination and confirmed by radiological evaluation. Asymptomatic patients were monitored at every 6 months with pelvic examination and pelvic ultrasonography to determine growth rate of fibroid and symptoms. Medical therapy with gonadotropin-releasing hormone agonist was given as an adjunct to surgical treatment where temporary postponement of surgery was required. Myomectomy, laparoscopic myomectomy, hysteroscopic myoma resection, uterine artery embolization and hysterectomy were performed as per individual patient indication. Postoperatively, all patients were followed for 1 year, and outcome of various procedures in relieving symptoms and fertility was recorded. Results: The incidence of fibroid uterus was 23%. The incidence of fibroid was more in 31–35 years, in nulliparous women. The incidence of symptoms was 52%; most common was menorrhagia (44.2%). Dysmenorrhea was the most common cause of pain (37.5%). Proportion of patients got relieved of symptoms was the highest with hysterectomy (92%). Highest conception rate was after laparotomy/myomectomy in 58.3%. Conclusion: Dysmenorrhea was the most common cause of pain. Hysterectomy was best for relief of symptoms. Laparotomy/myomectomy was best for those who want to conceive.

Influence of nutrition on the course of uterine fibroids

Currently, there is a negative trend in the increase in the incidence of uterine fibroids, often diagnosed at a later date, requiring more invasive laparotomic myomectomy, up to hysterectomy. It was also revealed that the patients had an aggravated premorbid background in the form of obesity and related diseases.The purpose of the study. To study domestic and foreign studies. To identify the features of the course of uterine fibroids in patients with hypersthenic and normosthenic body types.Materials and methods. Anonymous and voluntary questionnaire survey with an in-depth collection of food history, interviews of 260 patients and analysis of their case histories with uterine fibroids who underwent laparoscopic and laparotomic myomectomy were carried out, dividing them into 2 groups according to BMI.Results. In both groups, there was the following distribution according to the presence of pregnancies: 0 – 4 % and 5 %, 1 – 86 % and 84 %, 2 – 10 % and 11 % for groups I and II, respectively (p = 0.041 criterion). 25 % in group I and 31 % in group II had a history of surgery – caesarean section. The presence of inflammatory diseases of the pelvic organs in both groups was 89.3 % and 91.6 %, respectively. Also noted was a high consumption of beef and pork by 10 and 23 %, potatoes by 8 % and 13 %, white cabbage by 12 % and 11 %, bakery products by 21 % and 26 %. Low consumption of seafood and fish products by 35 % and 56 %, dairy products by 44 % and 47 %, absolutely low content of olive oil in the daily diet. The above data are presented for groups I and II, respectively. (criterion p = 0.029-0.054).Сonclusions. Obesity plays a role as a risk factor for the development of uterine fibroids, acting either through hormonal or inflammatory mechanisms. Obesity can contribute to the development of insulin resistance and hyperinsulinemia, which can directly or indirectly influence the development of fibroids by promoting the proliferation of myometrial smooth muscle cells and increasing circulating levels of ovarian hormones.

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

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

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

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