Laparotomic Myomectomy Research Articles

Unexpected early pregnancy during myomectomy followed by successful term delivery: A case report.

Leiomyoma, also known as uterine fibroid, is a non-malignant tumor originating from the uterus's smooth muscles. It is the most common benign tumor in the female genital tract, exhibiting varying size and form that can distort the uterus's shape. Uterine fibroids affect 2.7-10.7% of pregnant women and can lead to increased risks during pregnancy, such as miscarriage, placental abruption, preterm labor, and fetal malpresentation. Myomectomy is a surgical intervention for uterine fibroids, but it has drawbacks, including hemorrhage, fever, infection, ureter ligation, adhesive disorders, and unplanned hysterectomy. In this case report, we present a 32-yr-old woman with a large leiomyoma who underwent laparotomy myomectomy due to abdominal pain and heavy menstrual bleeding. 4 wk after the myomectomy, she was referred to the Obstetric Clinic of Ayatollah Taleghani hospital, Tehran, Iran complaining of delayed menstruation. Her beta-human chorionic gonadotropin test was positive. Ultrasound revealed a fetus with an estimated gestational age of 6 wk and 4 days. The pregnancy continued with no complications. At 38 wk of gestation, she underwent a cesarean section and delivered a healthy newborn. This case report supports previous publications that have demonstrated the safety of myomectomy during pregnancy.

Thinking in context: Fibroids-to-uterine volume ratio in pre-surgical fertility evaluation for intramural fibroids

ObjectiveTo explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. Study designThis is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter1*diameter2*diameter3*0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. ResultsA total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). ConclusionThe use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning.

Associations between the time interval from myomectomy to subsequent pregnancy and the obstetric outcomes: A population-based cohort study.

To investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth. A retrospective population-based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6-11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18-34 vs ≥35 years old). We observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22-3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49-14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6-11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14-2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16-9.24, P = 0.025) versus a TIMP of 6-11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17-4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17-3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06-15.53, P = 0.041); whereas women aged 18-34 years old did not. This study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old.

Minimizing Blood Loss in Laparotomic Myomectomy through the Tourniquet Use: Insights from Our Clinical Experience and Literature Review

The uterine tourniquet is often not used to reduce intraoperative blood loss due to controversial opinions in the literature. The objective was to evaluate the effectiveness of this procedure in laparotomic myomectomy. This is a retrospective, monocentric case-control study, including patients who underwent laparotomic myomectomy and were categorized into the Tourniquet Group (A) and No Tourniquet Group (B). The blood loss outcomes were compared. Intra-operative blood loss in Group A was 275 ± 200 mL, while in Group B was 410 ± 390 mL (p = 0.11). Notably, five patients in the No Tourniquet Group lost more than 1000 mL of blood and required blood transfusion, while no such cases were reported in the Tourniquet Group. Furthermore, the decrease in hemoglobin post-procedure was statistically significant, favoring Group A with a decrease of 1.9 ± 0.7 g/dL compared to Group B’s 2.8 ± 2.2 g/dL (p = 0.04). The use of the Foley catheter as a tourniquet during laparotomic myomectomy may represent a remarkable tool that profoundly impacts the surgical process by substantially reducing blood loss. Its use may play a role in significantly diminishing the likelihood of requiring blood transfusions, enhancing patient safety and outcomes, and should be systematically adopted.

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.

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.

Round Ligament Fibroid: A Case Report

Background: Round ligament fibroids are rare benign tumors that might manifest as vulvar, adnexal, or inguinal masses primarily because of their anatomical extension. Case Report: A 44-year-old lady who was not a known case of any medical illness was referred to the outpatient clinic in May 2022, after an incidental ultrasound finding of a subserosal fibroid. Upon examination, a hard mass was felt in the suprapubic area around 12 weeks size, yet due to the obese body type, proper examination was not possible. An ultrasound scan of the pelvis revealed multiple fibroids in the uterus, measuring 7x6 cm anteriorly, 4.5x3.5 cm posteriorly, and fundal 4.2x2.4 cm. After 12 months of conservative follow-up, another pelvic ultrasound scan was done, which revealed an anteverted bulky uterus measuring 11.9 x 8 cm, with multiple fibroids, the largest measuring 4.8x 4.5 cm at the lower uterine segment and 5.5x 4 cm at the fundus. These findings suggested a growing sessile subserosal uterine fibroid with extensions, dimensions, and relations. Finally, the patient was diagnosed with leiomyoma with cystic and hyaline degeneration, negative for atypia and malignancy. Laparotomy myomectomy was done, and the specimen consisted of a single oval mass weighing 410 gm and measuring 11x8x7.5 cm. Conclusion: The diagnosis of round ligament fibroid is often challenging due to its anatomical position. Keywords: Round ligament fibroid, laparotomy myomectomy, leiomyoma, case report

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

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

Outcomes of Laparotomic Myomectomy during Pregnancy for Symptomatic Uterine Fibroids: A Prospective Cohort Study.

Background: The incidence of pregnant women with uterine fibroids is increasing. As they are reactive to hormonal stimuli, in some cases, uterine fibroids tend to grow during pregnancy and potentially generate symptoms with different levels of severity, causing maternal-fetal complications. In very select cases, when other treatment strategies fail to manage symptoms and there is a substantial risk of adverse pregnancy outcomes, a surgical approach during pregnancy may be considered. Methods: From 2016 to 2021, the data from 28 pregnant women with symptomatic uterine fibroids who underwent laparotomic myomectomy during pregnancy were prospectively collected, and operative and maternal-fetal outcomes were analyzed (ClinicalTrial ID: NCT06009562). Results: The procedure was carried out between 14 and 16 weeks of pregnancy. Four (14.3%) patients had intraoperative complications (miscarriages) and nine (32.1%) had postoperative complications (threatened preterm birth). Overall, 24 (85.7%) women delivered at full term (mean: 38.2 gestational weeks), more than half (n = 13; 54.2%) by vaginal delivery, with normal fetal weights and 1 and 5 min Apgar scores. Conclusions: Laparotomic myomectomy during pregnancy can be considered in selected cases for uterine fibroids with severe symptoms when other treatment options have failed and there is high risk of adverse maternal-fetal outcomes.

An Extraordinary Location of Sentinel Lymph Nodes in a Patient with Endometrial Cancer

To show dissection of sentinel lymph nodes. A step-by-step demonstration of the technique with narration. Endometrial cancer (EC) is the most common gynecologic malignancy worldwide. Sentinel lymph node biopsy with indocyanine green (ICG) has become more widely used and has been featured in recently published guidelines for EC [1]. Minimally invasive approaches with the sentinel lymph node concept (conventional laparoscopy, laparoscopic-assisted vaginal surgeries or robotic) to EC staging have resulted in lower rates of peri- and postoperative complications than conventional staging procedures [2]. No video article has been published in the literature about high pelvic, para-aortic sentinel lymph node dissection. An informed consent form was obtained from the patient. An institutional review board approval was not required. A 45-year-old female with gravidity 0, parity 0, and body mass index of 23.4 kg/m2 presented with complaints of abnormal uterine bleeding (spotting). Increased endometrial thickness was detected on transvaginal ultrasound (10 mm) in the postmenstrual period. Endometrioid-type endometrial adenocancer with focal squamous differentiation International Federation of Gynecology and Obstetrics grade I was detected on endometrial biopsy. The patient had hepatitis B virus positivity and no other chronic disease. A laparotomic myomectomy had been performed in 2016. Laparoscopic high pelvic, low para-aortic sentinel lymph node dissection with ICG and hysterectomy (without uterine manipulator)+bilateral salpingo-oophorectomy were performed (Supplemental Video 1). The operation time for the procedure was 110 minutes and the estimated blood loss was <20 mL. No major complications occurred during or after the surgery. The patient stayed in the hospital for 1 day. The final pathology result showed an International Federation of Gynecology and Obstetrics grade I, endometrioid-type endometrial adenocancer with focal squamous differentiation, as a 1.5×1 cm tumorous mass invading less than one-half of the myometrium. Neither lymphovascular invasion nor sentinel lymph node metastasis was detected. A multicenter, prospective study showed that sentinel lymph node dissection with ICG in clinical stage 1 EC is feasible and has a high degree of diagnostic accuracy in detecting EC metastases. In that study, isolated para-aortic sentinel lymph node was detected in 3 of 340 patients (<1%) [2]. Another study reported the detection rate of isolated para-aortic sentinel lymph node to be 1.1% in patients with intermediate- and high-risk EC [3]. There are in some cases 2 distinct channels emanating from one side, and it is important to follow each and to acknowledge there may be more than one sentinel, one of which is lower in a typical location and one higher as in this case. This video article is the first video demonstration of bilateral isolated high pelvic, para-aortic sentinel lymph node dissection in EC.

A Case Report of Laparotomic Myomectomy After The Use of Gnrh Analogue in A Brazilian Woman

Uterine leiomyoma is the most common genital benign tumor in the female population. It is estimated that about 20 to 40% of women will have leiomyoma during their reproductive stage. IBGE (Brazilian Institute of Geography and Statistics) estimated the Brazilian population to be over 200 million Brazilians, of which half are women and approximately 50% are of reproductive age; hence, by calculating the prevalence of leiomyomatosis, there would be just over 6 million women with symptomatic fibroids in Brazil that require clinical or surgical treatment.[1-3-4] Due to its presence during the reproductive period, it can be caused by infertility or recurrent spontaneous pregnancy loss. Hence, myomectomy can be necessary when the fibroid itself causes distortion of the endometrial cavity, or competes with the embryo for the same place, or when conservative treatment was ineffective. This report describes a case of myomectomy which was performed after treatment with goserelin acetate with considerable reduction of fibroids volume, probably facilitating surgical approach, decreasing the blood loss and the risk of hysterectomy conversion. In addition, other GnRH analogue benefits before surgery such as doctor’s impression of decrease in size and better mobility of the tumor and patients feeling of decrease of the abdominal volume and the bleeding. This subjective approach can optimize the timing of surgery and establish the number of injections.

Diffuse Uterine Leiomyomatosis: A Case Report and Review of the Literature

<i>Background</i>: Diffuse uterine leiomyomatosis is a benign disease with a low incidence rate, mainly manifested as menorrhagia and infertility. Due to its clinical manifestations similar to multiple uterine myomas or adenomyosis, it is often misdiagnosed in clinical practice. Research has found that they can be distinguished through histopathological examination. According to existing reported cases, Diffuse uterine leiomyomatosis mainly occurs during the child-bearing period and has a significant impact on fertility. Hysterectomy is recognized as a radical cure, but uterine-sparing treatment methods need to be continuously explored. <i>Case</i>: A 41-year-old woman presented with recurrent menorrhagia 5 years after myomectomy. B-ultrasound examination indicated that the uterus was enlarged and the myometrium was full of hypoechoic, Considering the patient's desire to preserve the uterus, we performed laparotomy myomectomy again. <i>Result</i>: Hysteroscopic myomectomy has been shown to have a certain therapeutic effect on infertile patients in the early stage of DUL. Laparotomy myomectomy can remove a wider range of lesions and can be combined with gonadotropin releasing hormone agonists or antagonists for pretreatment. Uterine artery embolization is also a commonly administered therapy. High-intensity focused ultrasound ablation has been used with significant success in reducing uterine volume but requires further evaluation for its impact on fertility. <i>Conclusion</i>: A DUL patient underwent extensive myomectomy. This atudy further discussed uterine-sparing treatments, and reviewed existing research reports.

The use of sealing hemostat patch (HEMOPATCH®) in laparotomic myomectomy: a prospective case-control study.

Uterine myomas are the most common gynecological disease. In these cases, a myomectomy is performed traditionally laparotomically. However, alternatives have been widely used, including laparoscopic, endoscopic, and robotic surgery. During these techniques, diffuse parenchymatous bleeding remains one of the main intraoperative and postoperative complications and sometimes requires unplanned hysterectomies. Recently, hemostatic agents and sealants have been used to prevent excessive blood loss during surgical repair. We propose a prospective case-control study on the use of a sealing hemostat patch (HEMOPATCH®) on uterine sutures in laparotomic myomectomy. In the period between July 2016 and April 2017, 46 patients with symptomatic uterine fibromatosis underwent surgery. They were divided into two groups of 23 patients, with different treatments in the hemostatic phase of oozing bleeding. HEMOPATCH® is applied in group A, and spray electrocoagulation is applied in group B. In group A, we achieve faster hemostasis (p < 0.05), than in group B. We report a significantly lower C-reactive protein value on the second and third days after surgery for group A compared to group B. HEMOPATCH®, during laparotomic myomectomy, is a valid alternative solution for obtaining rapid hemostasis and consequently intraoperative and postoperative bleeding. Furthermore, we suggest that a lower inflammatory peritoneal state is probably correlated with the barrier effect of the patch on the suture.

Treatment of Cervical Leiomyoma: Case Report and Literature Review

Introduction: Uterine cervical fibroids are rare, accounting for about 5% of all myomas. Compared to myomas in general, cervical fibroids are located close to other organs such as the bladder, ureters, and rectum, so they require careful consideration in choosing the best surgical procedure. Case Presentation: A woman 40 years old comes to the gynecology outpatient clinic at the hospital with complaints vaginal bleeding and pain pelvis as well as difficulty defecating. Palpable abdominal examination results in mass congested as high as two fingers on symphysis. On examination, the vaginal, portion cervix is difficult to rate because there is a mass solid that is in the vagina part top. CT scan shows an existing mass in the cervix uteri measuring 7.57 cm × 7.6 cm × 7.95 cm. Cervical myoma diagnosis has then done laparotomy myomectomy next hysterectomy. Choice laparotomy because mass cervical large pressing myoma biological bladder and rectum so that difficult done laparoscopy. Conclusion: It has been reported cases of cervical myomas that have done laparotomy myomectomy and hysterectomy. No there are complications during and after surgery

Uterine Rupture as a Rare Complication in Pregnancies After Laparoscopic Myomectomy

Uterine leiomyomas can be treated with myomectomy. But there is a concern of uterine rupture in patients treated with myomectomy. The risk of rupture is higher in laparoscopic myomectomy than in laparotomic myomectomy. It may be related to the difference in surgical methods. Uterine rupture can be caused by previous surgical scars during labour or uterine enlargement with the progression of pregnancy. Here, we present two cases of uterine rupture occured in laparoscopic myomectomy scar in the second trimester. It should be kept in mind that rupture may develop after myomectomy and be considered in patients with abdominal pain and bleeding during pregnancy. Maternal and fetal morbidity and mortality may increase with delayed diagnosis and treatment.

Laparoscopic versus laparotomic myomectomy in infertility management and its pregnancy outcome in Nigeria

Uterine leiomyoma is common among black women of reproductive age in Africa and is associated with infertility. Its definitive means of treatment is myomectomy which can be approached by laparoscopy or laparotomy. There is a need to know if any of these two modes of treatment affects the chances of achieving pregnancy or its outcome in women with background infertility. Objective: To assess the proportion of women who achieved pregnancy after laparoscopic and laparotomic myomectomy with background infertility, their pregnancy outcome and a comparison of the two groups. Materials and Method: The study retrospectively reviewed 36 out of 188 women that had either laparoscopic (n=86) or laparotomic myomectomy (n=102) and achieved pregnancy over a period of 30 months. Result: There was pregnancy in 21 out of 86 women that had laparoscopy and 15 among the 102 women that had laparotomic myomectomy. This gave the pregnancy rates of 24.4% and 14.7% respectively. The pregnancy outcome was favourable and similar between the two groups with the laparoscopic group having a lower caesarean delivery rate of 76.2% compared to100% in the laparotomy group. The duration of hospital stay was significantly lower in the laparoscopy group. Conclusion: Laparoscopic or laparotomic myomectomy improves the chances of pregnancy in women with background infertility below 35 years. The laparoscopic group had a significantly lower caesarean section rate and a shorter duration of hospital stay than the laparotomic group, however, both groups had a similar and favourable pregnancy outcome.

Laparoscopic versus laparotomic myomectomy in infertility management and its pregnancy outcome in Nigeria

Laparoscopic versus laparotomic myomectomy in infertility management and its pregnancy outcome in Nigeria

Prevalence of Intrauterine Adhesions after Myomectomy: A Prospective Multicenter Observational Study

Objectives: The aim of this study was to evaluate intrauterine adhesion formation after laparoscopic and laparotomic myomectomy. Design: This is a prospective, multicenter, observational study (ClinicalTrials.gov ID: NCT04030273). Methods: We included patients after laparotomic and laparoscopic myomectomy. All patients underwent postsurgical diagnostic hysteroscopy, after 3 months. The intrauterine adhesion rate and associated factors were investigated. Results: Between January 2020 and December 2020, 38 and 24 consecutive patients underwent laparoscopic and laparotomic myomectomy, respectively. All diagnostic hysteroscopies were performed in the office setting without complications. Intrauterine adhesions were identified in 19.4% of women (95% CI: of 9–29%). Factors univariately associated (p < 0.2) with the presence of intrauterine adhesions after myomectomy were previous uterine surgery, the surgical approach (laparoscopic or laparotomic), the number of removed fibroids, the type and diameter of the largest myoma, and the opening of the uterine cavity. In the multivariable analysis, only the opening of the uterine cavity (odds ratio [OR] 51.99; 95% confidence interval [CI]: 4.53–596.28) and the laparotomic approach (OR, 16.19; 95% CI: 1.66–158.35) were independently associated with the identification of intrauterine adhesions after myomectomy. Limitations: One of the main limitations of our study is that we used uterine manipulator only in the laparoscopic group; in addition, we did not perform a preoperative hysteroscopy to evaluate the rate of intrauterine adhesions potentially present even before the myomectomy. Conclusions: The prevalence of intrauterine adhesions after 3 months from surgery was significantly associated with the opening of the uterine cavity and the laparotomic approach.

Surgical approach to uterine myomatosis in patients with infertility: open, laparoscopic, and robotic surgery; results according to the quantity of fibroids

ObjectiveTo compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis.MethodsObservational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results.Results69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979).ConclusionsThe surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.

Factors influencing surgical outcomes of laparoscopic myomectomy. A propensity-score matched analysis.

IntroductionTo evaluate factors influencing surgical choice in performing uterine myomectomy by comparing laparoscopic and open approach surgery.Material and methodsWe analyzed women undergoing uterine myomectomy in our hospital. Patients were divided into two groups: patients who underwent laparoscopic myomectomy (group A) and patients who underwent laparotomic myomectomy (group B). We matched 1 : 1 women in these two groups to compare the effects of the procedures on each outcome according to a propensity-matched score analysis.Results460 myomectomies were performed in the study period: 361 cases by laparoscopy (group A) and 99 cases by laparotomy (group B). We found lower estimated intraoperative blood loss (200 ml group A vs. 300 ml group B, < 0.0001) and a smaller decrease in hemoglobin value on the first postoperative day (1.7 g/dl group A vs. 2.2 g/dl group B, < 0.0001) with the laparoscopic approach. The propensity score matching estimated that to obtain an equivalent outcome, we required an average of 2 myomas and an average diameter of 8 cm in laparoscopy and 10 cm in laparotomy. Moreover, the variables mostly associated with a laparotomic conversion were the presence of a myoma > 8 cm and association with the presence of more than 2 myomas.ConclusionsDespite some proposals from previous studies, there are no specific guidelines regarding the best surgical procedure for myomectomy. Our data confirm that the choice of surgical technique should consider the patient characteristics and the surgeon experience to reduce longer operating times and more significant blood loss.