Large Uterine Myoma Research Articles

Venous Thrombosis Associated with a Large Uterine Myoma

Venous Thrombosis Associated with a Large Uterine Myoma

Laparoscopy-assisted Robotic Myomectomy Using the DA Vinci System

To report a case of a woman with a large uterine myoma who underwent laparoscopy-assisted robotic myomectomy using the da Vinci system. A 38-year-old, gravida 2, para 2, female patient presented to our office with a chief complaint of lower abdominal pressure and pain. A pelvic sonogram disclosed a subserosal myoma with a broad base, measuring approximately 9 x 8 x 7 cm, which was located at the anterior uterine wall. The patient insisted on preserving her uterus and was concerned with the cosmetic results after the surgery. She showed willingness to undergo myomectomy using the newly developed laparoscopy-assisted robotic system (da Vinci) and signed the consent form. The operation time was about 3 hours, with an estimated blood loss of 150 mL. The patient passed flatus and resumed oral intake on the following day. Minimally invasive surgery is the trend of the future. Robot-assisted laparoscopic surgery is a new technique for myomectomy. This robotic system provides a three-dimensional operative field and an easy-to-use control panel, which may be of great help when applying the suturing techniques and may shorten the learning curve. More experience with and long-term follow-up of robotic surgery may be warranted to further validate the role the robot-assisted approach in gynecologic surgery.

The Use of the Da Vinci Surgical System in Robotic Assisted Myomectomy: Initial Experience in the Removal of Intramural Myomas

Background and Significance: Myomectomy is considered the primary surgical treatment for women with large intramural uterine myomas desiring preservation of fertility. Historically, the most prevalent method of removal has been via laparotomy since laparoscopic removal of subserous and intramural myomas present even the skilled laparoscopic surgeon with considerable challenges, such as the ability to enucleate the myomas and complete a multilayered-suture repair of the uterine wall. The advent of robotic assisted laproscopic surgery has allowed one to overcome these challenges.Objective: To demonstrate feasibility of robotic assisted myomectomy in a heterogenous group of patients with varying BMI, myoma type, size, and number.Materials and Methods: A retrospective study investigating robotic assisted myomectomy over a 6-month period at a single institution and a single operator was conducted. All patients had either intramural and/or subserosal myomas.Tabled 1Robotic MyomectomyN = 19BMIAverage 29.6Std 7.4Min, max (18, 44)Number of fibroids∗Average 2.6Std 1.5Min, max (1, 6)Fibroid size (cm)Average 5.7Std 2.7Min, max (2.3, 15)Operation time∗∗ (min)Average 69.0Std 23.5Min, max (38, 118)Blood loss (mL)Average 123.1Std 60.0Min, max (30, 250)Length of hospital stay (h)Average 28.3Std 10.5Min, max (23, 48)Days to normal activityAverage 9.7Std 6.4Min, max (5, 28) Open table in a new tab ∗All fibroids intramural∗∗ no statistically significant difference in operative time between < 4cm and >4cm fibroidsConclusion: Based on our early results of robotic assisted myomectomy, we have demonstrated that this operation is feasible in patients with small-to-large body mass index, with fibroids ranging in size from 2–15 cm in diameter, that minimal blood loss is experienced during an operation of acceptable length with no associated morbidity. This series demonstrates that robotic assisted myomectomy is a safe and effective means to treat large intramural myomata, offering the patient a minimally invasive option of care with quick return to normal activity. Background and Significance: Myomectomy is considered the primary surgical treatment for women with large intramural uterine myomas desiring preservation of fertility. Historically, the most prevalent method of removal has been via laparotomy since laparoscopic removal of subserous and intramural myomas present even the skilled laparoscopic surgeon with considerable challenges, such as the ability to enucleate the myomas and complete a multilayered-suture repair of the uterine wall. The advent of robotic assisted laproscopic surgery has allowed one to overcome these challenges. Objective: To demonstrate feasibility of robotic assisted myomectomy in a heterogenous group of patients with varying BMI, myoma type, size, and number. Materials and Methods: A retrospective study investigating robotic assisted myomectomy over a 6-month period at a single institution and a single operator was conducted. All patients had either intramural and/or subserosal myomas. ∗All fibroids intramural ∗∗ no statistically significant difference in operative time between < 4cm and >4cm fibroids Conclusion: Based on our early results of robotic assisted myomectomy, we have demonstrated that this operation is feasible in patients with small-to-large body mass index, with fibroids ranging in size from 2–15 cm in diameter, that minimal blood loss is experienced during an operation of acceptable length with no associated morbidity. This series demonstrates that robotic assisted myomectomy is a safe and effective means to treat large intramural myomata, offering the patient a minimally invasive option of care with quick return to normal activity.

Erythropoietin and erythropoietin receptor system in a large uterine myoma of a patient with myomatous erythrocytosis syndrome: possible relationship with the pathogenesis of unusual tumor size

The rare condition of women with erythrocytosis and a concurrent myomatous uterus has been classified as "myomatous erythrocytosis syndrome". Substantial myoma size has been noted as a common denominator in this condition in which recent evidence have confirmed erythropoietin (Epo) production by myoma tissues themselves. Apart from its primary endocrine role in controlling erythropoiesis, Epo has been demonstrated to mediate several cellular processes such as angiogenesis, mitogenesis, and inhibition of apoptosis by autocrine and paracrine mechanisms. Recently, Epo and its receptor (Epo-R) have been shown to be involved in the growth, viability, and angiogenesis of several malignant tumors including human female reproductive organ malignancies. In this paper, we researched on Epo and, as a first in the literature, Epo-R immunoexpression in a large uterine myoma of a term pregnant patient suffering from the myomatous erythrocytosis syndrome. Eight nongravidic leiomyomas and 8 gravidic leiomyomas were used as control group samples. Apart from confirming Epo production by myoma smooth muscle cells in the myomatous erythrocytosis syndrome, we reveal in this pathologic condition a characteristic strong Epo-R expression in myoma endothelial cells and a weak and sporadic Epo-R expression in myoma smooth muscle cells. The striking presence of Epo-R within myoma tissues in the case of the myomatous erythrocytosis syndrome allows us to speculate that myoma Epo production, besides determining erythrocytosis through systemic effects, may contribute, acting by autocrine and paracrine mechanisms, in determining the large myoma size almost always observed in this condition. Finally, we confirm a less but specific immunostaining for Epo in uterine myomas of patients without erythrocytosis and, as a first in the literature, we prove a weak and sporadic Epo-R expression in these lesions. These last results may contribute to knowledge of the yet unclear etiopathogenesis of the most common human gynecologic neoplasm.

Leiomyosarcoma of the Sigmoid Mesocolon: Report of a Case

Although leiomyosarcoma arising primarily in the sigmoid mesocolon is rare, these sarcomas can be considered a special kind of retroperitoneal tumors. The clinical features are rarely obvious because of their location and lack of symptoms. Hence, they usually attain large sizes and may have metastases to distant sites at the time of diagnosis. Most authors agree on using computer tomography (CT) and nuclear magnetic resonance imaging (MIII) as diagnostic tools, but only histological examination can confirm the diagnosis, thus making a definitive pre-operative diagnosis difficult. We report the case of a 52-year-old female with low abdominal discomfort for 2 years, who mimicked having a large uterine myoma. During laparotomy, a tumor that was 13×7×6.5 cm in size was found on the sigmoid mesocolon. Curative resection was done, and the pathology confirmed a high-grade leiomyosarcoma. The post-operative survey revealed no evidence of distant metastasis.

Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy.

Abdominal myomectomy and hysterectomy remain the traditional treatment of large symptomatic uterine myomas. The preoperative indications for abdominal myomectomy or hysterectomy must be clearly evaluated and delineated avoid unnecessary intervention. There appears to be an increasing trend toward expectant management for asymptomatic uterine myomas. Women should consider the options of myomectomy and hysterectomy when their symptoms are severe enough to warrant intervention and the benefits of intervention outweigh the risks. The advantages and disadvantages of preoperative medical also must be addressed before intervention. The factors influencing the choice of therapy seem to be strongly dependent on both the patient and physician preferences. A clinical approach to abdominal myomectomy in patients with infertility and repetitive miscarriage has been presented in this chapter. The rapid development and use of minimally invasive innovations and adjunctive medical therapies has provided clinicians with a wealth of alternatives. A practical and cost-effective approach based on the data currently available have been presented; however, there remains a paucity of prospective randomized data to evaluate and compare the effectiveness and safety of these alternative treatments to abdominal myomectomy and hysterectomy. Future studies should help define the optimal candidates for traditional surgical treatment with abdominal myomectomy and hysterectomy.

Large uterine myoma with erythropoietin messenger RNA and erythrocytosis

Background: Myomatous erythrocytosis syndrome (erythrocytosis associated with a uterine myoma) has multiple proposed etiologies, one of which is altered erythropoietin production. Case: A 28-year-old woman, gravida 0, para 0, presented with a solitary, degenerated uterine myoma that was 34–36 weeks’ gestational size and erythrocytosis. After GnRH agonist treatment and myomectomy, the tumor was analyzed by reverse transcription–polymerase chain reaction. Specific erythropoietin primer with erythropoietin messenger RNA was noted. Conclusion: Erythropoietin production by myomata might cause erythrocytosis in myomatous erythrocytosis syndrome.

Laparoscopy‐assisted myomectomy of large uterine myomas

Objectives To compare laparoscopic‐assisted myomectomy with myomectomy by laparotomy. Design Non‐prospective study. Patients Women with large uterine myoma of &gt;16 weeks. Interventions Laparoscopic‐assisted myomectomy (n = 31) and myomectomy by laparotomy (n = 29). Results The mean diameter and the weight of the myoma were 12.7 ± 3.5 cm and 267.5 ± 36.0 g in the laparoscopy‐assisted myomectomy group and 9.1 ± 0.6 cm and 332.6 ± 62.9 g in the laparotomy group. The mean length of hospital stay was significantly shorter in women who underwent laparoscopic‐assisted myomectomy (3.2 ± 0.2 days) than in those who underwent myomectomy by laparotomy (5.1 ± 0.3 days). Conclusions Laparoscopic‐assisted myomectomy is as effective as myomectomy by laparotomy, but it is associated with a smaller abdominal incision and shorter hospital stay.

Cherney versus midline vertical incision for myomectomy or hysterectomy of a significantly enlarged uterus

OBJECTIVE: Our purpose was to determine whether a different in clinical outcome could be demonstrated with the choice of Cherney versus vertical incision in patients undergoing surgical treatment of large benign uterine myomas. STUDY DESIGN: Twenty consecutive patients underwent hysterectomy or myomectomy for a large (five or more times normal size) myomatous uterus through a Cherney incision. A pathologist blinded for clinical outcome matched the specimens removed from the Cherney group with 20 others removed through vertical incisions during the corresponding period on the basis of specimen weight alone. A chart review was undertaken to determine significant demographic and outcome variables, with particular attention to clinical course and operative complications. RESULTS: The groups were similar in age, race, parity, body mass index, preoperative hematocrit, associated illnesses, type of anesthesia and anesthetic agents, associated surgical fiindings, and associated surgical procedures. No significant differences were detected in the duration of anesthesia, surgical procedure or hospital stay, volume of perioperative blood loss, narcotic analgesic usage, or the number of minor or major complications. Trends toward greater blood loss, transfusion, and complications in the vertical group may have been related to exposure, whereas longer duration of surgery and greater postoperative analgesic use were seen with Cherney incisions. CONCLUSION: No clinical difference could be demonstrated with incision choice in a group of 40 patients having surgical treatment of large uterine myomas.

Multiple therapies for vaginal bleeding secondary to large uterine myomas

Acute vaginal bleeding secondary to uterine myomas can be a devastating event. We report the use of a combined therapeutic approach in a patient who presented with protracted bleeding of a myomatous uterus that was equivalent in size to a 38 week gestation. This patient's course was further complicated by her refusal of blood or blood products.

Association of a Persistently Retroverted Gravid Uterus with a Large Myoma

ABSTRACTA case of persistently retroverted gravid uterus associated with a large uterine myoma is presented. Laparotomy was performed to exclude an ovarian mass and to replace the uterus. Pregnancy progressed with no complication.

Ultrasonic aortography: unexpected findings

In a series of 125 patients examined ultrasonically for suspected abdominal aortic aneurysms, 15 patients (12%) had intraabdominal abnormalities unrelated to the aorta. In 12 of these patients, a retroperitoneal malignancy clinically mimicked an aneurysm. In the remaining three, other abnormalities were discovered in addition to an aneurysm. In one patient, a large uterine myoma was visualized; in another, large retroperitoneal lymph nodes subsequently proved to be lymphoma; in the third, enlarged lymph nodes in association with a carcinoma of the colon were discovered. Because of the high incidence of unsuspected findings, ultrasonography should become an essential part of the evaluation of this group of patients.

Microangiographic observations on the uterine and maternal placental vasculature in early human pregnancy

Four patients at 12 to 16 weeks' gestation were admitted to the hospital for legal abortion and sterilization. Because of large uterine myomas, hysterectomy was performed. Three intact pregnant uteri thus obtained were successfully perfused through the arteries or veins with a barium sulfate suspension. The filled vascular compartments were studied with microangiography and histologic methods. Arterial perfusion freely filled all the myometrial vessels and the intervillous space and also demonstrated the wide thin-walled veins which drain the latter. Morphologic evidence suggests that these veins are important in transporting humoral substances from the fetoplacental unit to the myometrium. Venous perfusion did not lead to filling of the intervillous space, probably because the dilated veins within the myometrium and decidual plate produced increased intrauterine pressure.

A study of frozen sections through a cadaver showing the anatomical relations of a large uterine myoma: Dr. J. Whitridge Williams, Baltimore, Maryland, presented of which the following is an abstract

A study of frozen sections through a cadaver showing the anatomical relations of a large uterine myoma: Dr. J. Whitridge Williams, Baltimore, Maryland, presented of which the following is an abstract