Location Of Myomas Research Articles

Overview of Uterine Fibroid Treatment Procedures; Review Article

Myomas are benign uterine tumours found in 40-70% of women of reproductive age. About 30% of them cause various ailments (bleeding, pain, infertility) that reduce the quality of women’s life. Uterine fibromas are the cause of 40-60% of hysterectomies. Different treatment methods are used depending on the size, number, location of myomas and the patient's preferences. Conservative treatment includes nonsteroidal anti-inflammatory drugs, hormonal therapies as contraceptives, GnRH agonists or antagonists, selective progesterone receptor modulators and levonorgestrel. Radiologic intervention types include are UAE (uterine artery embolization), high-intensity focused ultrasound (HIFU), magnetic resonance (MRgFUS), and radiofrequency ablation (RFA). There are also more radical methods, namely surgical treatments, such as myomectomy (hysteroscopic, laparoscopic, robotic or abdominal) and hysterectomy. The oldest of methods is abdominal hysterectomy, while in some women, vaginal hysterectomy can be applied. Recently, laparoscopic or robotic hysterectomy (using the da Vinci robot) has been used. The latter procedures are associated with a better quality of life following treatment.

Evaluating Surgical Complexity of Endoscopic Hysterectomy: An Inter-rater and Intra-rater Agreement Study of Novel Scoring Tool

Evaluate inter-rater and intrarater reliability of a novel scoring tool for surgical complexity assessment of endoscopic hysterectomy. Validation study. Academic medical center. Total of 11 academic obstetrician-gynecologists with varying years of postresidency training, clinical practice, and surgical volumes. Application of a novel scoring tool to evaluate surgical complexity of 150 sets of images taken in a standardized fashion before surgical intervention (global pelvis, anterior cul-de-sac, posterior cul-de-sac, right adnexa, left adnexa). Using only these images, raters were asked to assess uterine size, number, and location of myomas, adnexal and uterine mobility, need for ureterolysis, and presence of endometriosis or adhesions in relevant locations. Surgical complexity was staged on a scale of 1 to 4 (low to high complexity). Number of postresidency years in practice for participating surgeons ranged from 2 to 15, with an average of 8 years. A total of 8 obstetrician-gynecologists (72.7%) had completed a fellowship in minimally invasive gynecologic surgery. Six (54.6%) reported an annual volume of >50 hysterectomies. Raters reported that 95.4% of the images were satisfactory for assessment. Of the 150 sets of images, most were found to be stage 1 to 2 complexity (stage 1: 23.8%, stage 2: 41.6%, stage 3: 32.8%, stage 4: 1.8%). The level of inter-rater agreement regarding stage 1 to 2 vs 3 to 4 complexity was moderate (κ=0.49; 95%confidence interval [CI], 0.42-0.56). Moderate inter-rater agreement was also found between surgeon raters with an annual hysterectomy volume >50 (κ=0.49; 95%CI, 0.40-0.57) as well as between surgeon raters with fellowship experience (κ=0.50; 95%CI, 0.42-0.58). Intrarater agreement averaged 80.2% among all raters and also achieved moderate agreement (mean weighted κ=0.53; range, 0.38-0.72). This novel scoring tool uses clinical assessment of preintervention anatomic images to stratify the surgical complexity of endoscopic hysterectomy. It has rich and comprehensive evaluation capabilities and achieved moderate inter-rater and intrarater agreement. The tool can be used in conjunction with or instead of traditional markers of surgical complexity such as uterine weight, estimated blood loss, and operative time.

Clinicopathological features and prognostic factors for uterine myoma.

Objectives:To investigate the clinicopathological features of patients with uterine myoma and to analyze and summarize factors affecting patient prognosis.Methods:This study retrospectively investigated records of uterine myoma patients treated at Huzhou Central Hospital between June 2018 and May 2020. A total of 149 patients were included in this study, including 121 patients with good prognosis and 28 patients with poor prognosis. Clinical and pathological characteristics, including age, average body mass index (BMI), menopausal status, average lesion diameter, presence of hypertension or diabetes mellitus, operation method, myoma type, location, and quantity, number of fibroids, and presence of pelvic adhesion were analyzed via multivariate analysis.Results:Among the 149 patients with uterine uterine myoma, 92 had anterior wall uterine myoma, 36 had posterior wall uterine myoma, and 21 had uterine fundus uterine myoma. In terms of location, 94 cases were intramural and 55 cases were subserosal. Quantity-wise, 107 had 1-3 myomas while 42 had four or more. Moderate or more severe pelvic adhesions were present in 33 cases. Univariate analysis showed significant differences in age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity between patients with good and poor prognosis. Multivariate analysis showed that age, surgical method, uterine myoma type, uterine myoma location, uterine myoma quantity, and pelvic adhesion severity were risk factors affecting the prognosis.Conclusion:Many prognostic factors, including age, operation method, myoma type, myoma location, myoma number, and pelvic adhesion severity are linked to uterine myoma patient prognosis.

Predictors of Spontaneous Conception Following Myomectomy among Women with Infertility at Federal Medical Centre Yenagoa, Nigeria


 Background: Uterine fibroid or leiomyoma (myoma) is the commonest uterine neoplasm in women, and it has been associated with infertility. Though it’s not regarded as a direct cause, surgical removal (myomectomy) has been reported to increase the spontaneous conception rate in women with infertility.
 Objective: The objective of this study was to determine the factors associated with conception after myomectomy in women with infertility. It would determine the pregnancy rate, demographic, and surgical factors (pre and postoperative factors).
 Materials and Methods: This was a retrospective observational study of 107 women who had myomectomy during the study period, out of these, 68 were done for infertility. The case notes of these women were retrieved, and information related to demographic factors obtained was: maternal age, parity, address, tribe, educational level, and occupation. The preoperative surgical factors obtained were previous history of myomectomy, indication for myomectomy, the size, number and location of myomas, and the caliber of the surgeon. Postoperative surgical data collected include conception, interval between myomectomy and conception, pregnancy outcome, mode of delivery, and fetal sex and birth weight. Categorical variables were compared with chi square and odds ratio, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis.
 Results: The infertility rate among the women who had myomectomy was 63.6%, the conception rate was 14.7%, and the mean myomectomy to pregnancy interval was 9.20 ± 1.24 months. The factors that favor conception were: younger women P = 0.003, uterine size ≤ 16 weeks odds ratio = 3.50(0.14, 84.20), high parity (p = 0.002), solitary fibroid odd ratio = 2.65(0.44, 16.04), tertiary education P = 0.0001 and surgery by consultants P = 0.004. Others were absence of submucous myomas, and pelvic pathology at laparotomy. Using multivariate analysis, the most significant predictors for conception were age and parity, accounting for 10.7%, and all the factors put together could only explain 36.5%.
 Conclusion: The conception rate following myomectomy in Yenagoa was relatively low, and the most important predictors were maternal age and parity. The bulk of the factors (65.5%) that determine conception are outside the scope of our study; these could be male factor infertility, factors within the tubal lumen, unidentified uterine synechia, and ovarian failure.

Myoma, fortuitous discovery or metrorrhagia: Which is more revealing?

Introductionle myome est une pathologie fréquente dans notre contexte, découverte de façon fortuite ou par des métrorragies; notre objectif était de mesurer l´association entre la taille des myomes et leur circonstance de découverte, et entre le siège des myomes et la survenue de métrorragies.Méthodesnous avons mené une étude transversale de 6 ans de janvier 2012 à décembre 2018 incluant les femmes de 18 ans et plus reçues au Centre Hospitalier Universitaire (CHU) Bogodogo pour une échographie pelvienne ou abdomino pelvienne, chez qui au moins un myome utérin a été découvert. L'analyse a consisté en une régression logistique binaire pour la métrorragie et multinomiale pour les circonstances de découverte et la taille.Résultatsnous avons analysé 1049 femmes, chez qui 2294 myomes ont été répertorié par échographie: soit 2 myomes par femme. L´âge moyen était de 37 ans. Les femmes dont le plus gros myome était supérieur à 50mm représentaient 29,7% (n=311). Il existait une forte association entre le siège interstitiel, sous-séreux ou sous-muqueux et la survenue de métrorragies (p<0,001). La taille inférieure à 50mm était significativement associée à une découverte fortuite (p=0,016), mais pas à une métrorragie révélatrice (p=0,084). Les femmes qui avaient des myomes sous-muqueux (OR=3,13; IC95%= [1,45-6,76]), interstitiel et sous-muqueux (OR=2,24; IC95%= [1,05-4,78] et interstitiel, sous-séreux et sous muqueux (OR=3,57; IC95%= [1,88-6,76]) avaient une côte de présenter une métrorragie plus élevée. Les myomes inférieurs à 50mm avaient un rapport de cote deux fois plus élevé de se révéler de façon fortuite (RRR=1,80; IC95%= [1,25-2,62]) ou par des métrorragies (RRR=1,75; IC95%= [1,04-2,95].Conclusionles associations de siège des myomes sont plus à risque de métrorragie.

The Effect of Myoma Uteri on Infertility

Myoma uteri are the most prevalent firm of benign gynecological tumors found in women. Their effects on reproductive function and fertility are unknown. Treatment is dependent on myoma's location and size. While there is medical consensus on the treatment of submucosal myoma, there exists controversy in treatment and management of intramural myoma in infertile patients. Surgical treatments include hysteroscopic, laparoscopic and open myomectomies (laparotomy). Results from endoscopic and open myomectomies are comparable. Endoscopic treatment is generally favored due to lower morbidity, same day treatment, shorter hospitalizations and lower costs. Alternative methods, including medical and radiological intervention, are discussed.

2948 Prospective, Single-Blinded Pilot Study: Bimanual Pelvic Examination Versus Pelvic Ultrasound Results in Symptomatic Women

Study Objective To compare the results of bimanual pelvic exam (BPE) to Pelvic Ultrasound (PU) in symptomatic women. The American College of Physicians reported that 35% of women may experience pain, discomfort, embarrassment, or anxiety during a pelvic exam. This may serve as a barrier for women to seek medical care, which could potentially delay diagnosis. While prior studies show lack of evidence for routine BPE in asymptomatic women, its use in symptomatic women may also be limited. Design Prospective single-blinded pilot study. Setting Free-standing ambulatory surgery center serving the Washington, DC area. Patients or Participants Women, 18 years or older, with BMI < 40, presenting for evaluation of symptomatic gynecologic problems. Interventions BPE was performed by an experienced gynecologist blinded to the patient's previous ultrasound results. The sonographer was also blinded to BPE results. Measurements and Main Results A total of 20 patients were evaluated, 45% for abnormal uterine bleeding, 60% for pelvic pain or dysmenorrhea, 25% for infertility or pregnancy losses, and 15% for post-menopausal bleeding. While PU indicated adnexal abnormalities in 25% of patients (hydrosalpinx, ovarian cysts or endometrioma), BPE only identified 1 case, for a detection rate of 20%. PU identified myomas in 80% of the cases, while BPE detected only 5 cases, for a detection rate of 31%. Although the size and location of myomas were mostly undetermined by BPE, it did accurately assess uterine size in 80% of the cases. Conclusion BPE offers little clinical utility in diagnosing gynecologic problems in symptomatic women. A full prospective study of a large number of patients is in progress to further validate these results. To compare the results of bimanual pelvic exam (BPE) to Pelvic Ultrasound (PU) in symptomatic women. The American College of Physicians reported that 35% of women may experience pain, discomfort, embarrassment, or anxiety during a pelvic exam. This may serve as a barrier for women to seek medical care, which could potentially delay diagnosis. While prior studies show lack of evidence for routine BPE in asymptomatic women, its use in symptomatic women may also be limited. Prospective single-blinded pilot study. Free-standing ambulatory surgery center serving the Washington, DC area. Women, 18 years or older, with BMI < 40, presenting for evaluation of symptomatic gynecologic problems. BPE was performed by an experienced gynecologist blinded to the patient's previous ultrasound results. The sonographer was also blinded to BPE results. A total of 20 patients were evaluated, 45% for abnormal uterine bleeding, 60% for pelvic pain or dysmenorrhea, 25% for infertility or pregnancy losses, and 15% for post-menopausal bleeding. While PU indicated adnexal abnormalities in 25% of patients (hydrosalpinx, ovarian cysts or endometrioma), BPE only identified 1 case, for a detection rate of 20%. PU identified myomas in 80% of the cases, while BPE detected only 5 cases, for a detection rate of 31%. Although the size and location of myomas were mostly undetermined by BPE, it did accurately assess uterine size in 80% of the cases. BPE offers little clinical utility in diagnosing gynecologic problems in symptomatic women. A full prospective study of a large number of patients is in progress to further validate these results.

Ultrasound Guided Robotic Assisted Myomectomy

Ultrasound Guided Robotic Assisted Laparoscopic Myomectomy A Video Presentation Video Objective The purpose of this video is to demonstrate how intraoperative sonography can assist during robotic myomectomy. Ultrasound can help better determine the location of the myoma and used at the end of the procedure to make sure all myomas are removed. It is easy to use and a helpful resource during myomectomies, especially when tactile feedback is lost during robotic surgery. Setting Two patients were selected for this video. The first patient is a 39 year old female with pain for years found to have a 14cm intramural myoma. The second patient is a 33 year old referred from REI clinic for surgery when myomas were incidentally found during infertility work up. Interventions Both patients underwent a ultrasound assisted robotic myomectomy. Conclusion Intraoperative ultrasound is safe and easy to use. It is extremely helpful for intramural myomas (type 2-4). The ultrasound images are seen easily on the surgeon console without reducing the optics. The BK sono allows for real time imaging during surgery to evaluate the depth of myometrial invasion as well as location of myomas that may not be clearly visible intraoperatively. It provides a real time visual that can be used in conjunction with preoperative imaging.

Ultrasonographic Features of Uterine Scar after Laparoscopic and Laparoscopy-Assisted Minilaparotomy Myomectomy: A Comparative Study

To evaluate uterine scar features after laparoscopic myomectomy (LM) compared with myomectomy performed by laparoscopy initially and then completed with minilaparotomy (LAM). Prospective cohort study. An academic center for advanced endoscopic gynecologic surgery. Sixty-nine symptomatic women who underwent myomectomy between July and December 2018. Patients underwent LM or LAM and 3-month follow-up ultrasonography. Forty-four patients underwent LM and 25 underwent LAM. Demographic data, intraoperative parameters, and postoperative outcomes were collected. Two-dimensional color Doppler ultrasound was done at a 3-month follow-up to evaluate myomectomy scar features, myometrial thickness, and the presence of and vascularity of a heterogeneous mass. These features were compared with those of the intact myometrium on the opposite wall of the patient's uterus. The 2 groups had similar demographic characteristics, and there were no significant between-group differences in the number, maximum diameter, type, or location of myomas. The mean myometrial thickness at the scar site was 18.9 ± 3.22 mm in the LM group and 19.7 ± 3.50 mm in the LAM group, with no significant difference between the 2 groups. There was no meaningful difference in vascularity between the scar and normal myometrium. Heterogeneous masses were detected in 23% of patients in the LM group and in 24% of those in the LAM group. Other than mean operative time (207 minutes for LM vs 150 minutes for LAM; p < .001) and mean postoperative reduction in hemoglobin (1.77 mg/dL for LM vs 2.35 mg/dL for LAM; p = .023), there were no other statistical differences between the 2 groups. One patient in the LM group experienced a bowel injury resulting from morcellation. There were no differences in myometrial scar features after LM compared with after LAM, implying effective suturing via both approaches.

Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time

To develop a preoperative calculator to predict the total operative time (TOT) for robotic-assisted laparoscopic myomectomy (RALM). Retrospective cross-sectional study. University medical center. Women who underwent RALM performed by 3 high-volume surgeons at a single institution between January 2014 and December 2017. Demographic characteristics, indication for surgery, surgical history, myoma burden on imaging, and TOT were collected. RALM operative time was classified as <3 hours, 3 to 5 hours, and >5 hours. We identified preoperative characteristics predictive of increased operative time and developed a preoperative calculator to estimate TOT. A total of 126 women underwent RALM during the study period, with a mean TOT of 213 minutes ± 66 minutes. The mean total weight of myomas removed was 264 g ± 236 g, and mean largest myoma diameter was 8.5 cm ± 2.6 cm. Overall, mean number of myomas removed was 2.5 ± 2.4, and estimated blood loss (EBL) was 215 ± 212 mL. Five patients (4.0%) received a blood transfusion, and 4 patients (3.2%) underwent conversion to laparotomy. Preoperative factors significantly associated with TOT included patient age, personal history of diabetes mellitus, uterine volume, number of myomas, number of myomas >3 cm, diameter of the dominant myoma, and surgeon experience. The mean uterine volume was 282 cm3 for procedures with a TOT <3 hours, 461 cm3 for procedures with a TOT of 3 to 5 hours, and 532 cm3 for procedures with a TOT >5 hours (p = .004). Body mass index, personal history of hypertension, previous abdominal/pelvic surgery, surgical indication, location of dominant myoma (anterior, posterior, or fundal) and classification of dominant myoma (submucosal, intramural, subserosal, or other) were not associated with TOT. Our preoperative calculator correctly predicted TOT category in 88% of the patients and estimated TOT within a 1-hour margin in 80% of patients. RALM is becoming a more popular surgical approach for the management of uterine myomas. Preoperative radiographic evaluation and a thorough patient history may enhance patient counseling and surgical planning. Uterine volume and myoma number and size appear to be more predictive of TOT compared with myoma location.

Myoma Imaging by Gynecologic Surgeons Training in Intraoperative Ultrasound Technique

To compare preoperative transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) with intraoperative ultrasound (IOUS) in surgeons first learning to use this technique. A prospective study of IOUS accuracy for mapping the size and location of myomas compared with TVUS or MRI (Canadian Task Force classification II-2). Five University of California academic centers (Davis, Irvine, Los Angeles, San Diego, and San Francisco). Twenty-six premenopausal women seeking uterine-sparing surgical treatment of myomas. Eligible participants could have no more than 6 myomas ≥2 cm and <10 cm and a uterine size no larger than 16 weeks by pelvic examination. Measurement of myomas by IOUS followed by radiofrequency ablation (RFA) of fibroids. Eligible participants had to have imaging with TVUS or MRI within the last year to assess myoma characteristics. During the RFA operation, surgeons who had undergone a 1-day training on RFA and IOUS measured all myomas visualized with IOUS. Surgeons measured more myomas than were reported on MRI (12 on MRI and 16 on IOUS) or TVUS (41 on TVUS and 62 on IOUS) in all positions (anterior, posterior, lateral, and fundal). In particular, they identified more myomas <2 cm (4 on MRI, 9 on IOUS, 1 on TVUS, and 19 on IOUS). They located 2.3 times as many myomas in the anterior position as TVUS. For the myomas ≥2 cm identified by IOUS and MRI or IOUS and TVUS, there was no statistically significant difference in the mean myoma number or the mean myoma diameter measurements. Surgeons first learning to use IOUS detect the same number of myomas ≥2 cm as identified by TVUS and MRI and find a greater number of myomas <2 cm on IOUS compared with radiologist-reported TVUS.

A Fast 3-Dimensional Magnetic Resonance Imaging Reconstruction for Surgical Planning of Uterine Myomectomy.

BackgroundUterine myoma is the most common benign gynecologic tumor in reproductive-aged women. During myomectomy for women who want to preserve fertility, it is advisable to detect and remove all myomas to decrease the risk of additional surgery. However, finding myomas during surgery is often challenging, especially for deep-seated myomas. Therefore, three-dimensional (3D) preoperative localization of myomas can be helpful for the surgical planning for myomectomy. However, the previously reported manual 3D segmenting method takes too much time and effort for clinical use. The objective of this study was to propose a new method of rapid 3D visualization of uterine myoma using a uterine template.MethodsMagnetic resonance images were listed according to the slide spacing on each plane of the multiplanar reconstruction, and images that were determined to be myomas were selected by simply scrolling the mouse down. By using the selected images, a 3D grid with a slide spacing interval was constructed and filled on its plane and finally registered to a uterine template.ResultsThe location of multiple myomas in the uterus was visualized in 3D and this proposed method is over 95% faster than the existing manual-segmentation method. Not only the size and location of the myomas, but also the shortest distance between the uterine surface and the myomas, can be calculated. This technique also enables the surgeon to know the number of total, removed, and remaining myomas on the 3D image.ConclusionThis proposed 3D reconstruction method with a uterine template enables faster 3D visualization of myomas.

Size, Type, and Location of Myoma as Predictors for Successful Laparoscopic Myomectomy: A Tertiary Government Hospital Experience.

Background:Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM.Methodology:Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed.Results:There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010).Conclusion:LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.

Mifepristone Therapy in Symptomatic Leiomyomata Using a Variable Dose Pattern with a Favourable Outcome.

Background:Leiomyomata causing symptoms have a deleterious effect on the health of women during reproductive age. Mifepristone, a progesterone antagonist was studied for reduction of symptoms in leiomyomata in perimenopausal women.Material and Methods:Mifepristone was adminstered to 7 women aged 47-50 years. Another 3 women less than 47 years were taken up for comparison of benefit of Mifepristone on leiomyomata related symptoms. Mifepristone was given in a stepwise declining dose for a period of 9 months to 1 year . The treatment was begun with 25 mg and the dose was reduced every 3 months. Every 3 months, the size of myomas, bleeding pattern, location of myomas, endometrial thickness, haemoglobin, and any side effects were all recorded.Results:There was considerable amelioration in the symptoms in both premenopausal as well as perimenopausal women, while mifepristone was continued. The reduction in myoma size was found to be statistically significant. After stoppage of drug in women aged 40-45 years, i.e. premenopausal group, the symptoms returned. However, in perimenopausal women, in 6 out of 7 women the symtoms abated completely and they had a smooth transition to menopause.Conclusion:Mifepristone is a very promising drug for conservative management of leiomyomata, especially in perimenopausal age (47years or more), where hysterectomy was averted in all 7 women.

445 - Size, Type and Location of Myoma as Predictors for Successful Laparoscopic Myomectomy: a Tertiary Government Hospital Experience

445 - Size, Type and Location of Myoma as Predictors for Successful Laparoscopic Myomectomy: a Tertiary Government Hospital Experience

Robotic Single-Site Myomectomy: Clinical Analysis of 61 Consecutive Cases

Study ObjectivesTo report 61 consecutive cases of successful robotic single-site myomectomy (RSSM), and to evaluate the feasibility and safety of RSSM. DesignRetrospective analysis of 61 cases involving RSSM (Canadian Task Force classification III). SettingDepartment of Obstetrics and Gynecology, College of Medicine, Robot Surgery Center, Ewha Womans University, Seoul, Republic of Korea. PatientsSixty-one patients who underwent RSSM performed by 3 gynecologic surgeons at Ewha Womans University between December 2014 and May 2016. InterventionsWe analyzed the patients' baseline characteristics and surgical variables and the trends in operation-related variables according to surgeon's level of experience with RSSM. Measurements and Main ResultsThere were no cases of conversion to laparotomy or robotic multisite myomectomy. RSSM was successful for multiple uterine myomas up to 12 in number and for large myomas up to 12.8 cm in longest diameter. In terms of myoma location, RSSM was successful for all types of myomas, including subserosal, intramural, and intraligamentary. The mean docking time was 5.45 ± 2.84 minutes (2.0∼12.0 minutes), mean total operation time was 135.98 ± 59.62 minutes (60∼295 minutes), mean estimated blood loss was 182.62 ± 153.02 mL (10∼600 mL), and mean skin incision length was 2.70 ± 0.19 cm (2.4∼3.10 cm). The mean time to postoperative gas passage was 28.71 ± 12.99 hours (3.33∼76.50 hours), and the mean duration of hospitalization was 4.21 ± 0.84 days (3∼6 days). No patient required additional analgesics other than applied intravenous patient-controlled analgesia. The mean change in hemoglobin level was 2.43 ± 0.87 g/dL, and the incidence of postoperative anemia requiring blood transfusion was only 3.3% (2 cases). No intraoperative or perioperative complications were noted. ConclusionRSSM is a feasible and safe procedure even in cases large, multiple, and intramural type myomas. Therefore, this option could be extended to appropriately selected patients.

Diagnosis and treatment of uterine myoma

Uterine fibroid is the most common tumor in women of reproductive age. Depending on the size and location they can cause variety of symptoms. The clinical presentation may include bleeding disorders, infertility, pelvic pain and dysmenorrhea as well. Detection and precise evaluation of the number, size and location of myomas is possible due to advances in imaging and endoscopic methods. Treatment of fibroids depends on the severity and type of symptoms. There are medical, radiological and surgical options for treatment. Debates on fibroid management are widely published and are in focus recently, related to the "fibroid-scandal" occurred in the United States.

Myoma-associated pain frequency and intensity: a retrospective evaluation of 1548 myoma patients

ObjectiveTo analyze the possible relation between symptoms (especially pain) reported by myoma patients and objective features of their myomas as determined by ultrasound. Specifically: (1) What is the frequency and intensity of myoma-related pain? (2) Does the pain intensity depend on the number, size, or location of the myomas? (3) Is there any correlation between premenstrual pain, menstrual pain, and pain during sexual intercourse? Study designA retrospective analysis of data from a patient questionnaire and ultrasound exams, collected from February 2009 until January 2013 at the myoma clinic of a university hospital in a large European city. The study analyzed data from 1548 myoma patients. Patients completed a 0–10 Likert scale questionnaire about their symptoms. The number, size, and location of myomas were determined from ultrasound exams. ResultsThe three most frequent symptoms reported were hypermenorrhea, dysmenorrhea, and premenstrual pain. There was no statistically significant relationship between premenstrual pain or pain during sexual intercourse on the one hand and the number, size, or location of myomas on the other hand. For women with severe dysmenorrhea (Likert-scale scores of 8–10), submucosal myomas were significantly more frequent than all other myoma locations (p=0.01). Severe dysmenorrhea (Likert-scale scores of 8–10) was reported by a significantly (p<0.001) greater portion of the women whose largest myoma had a largest diameter of <5cm than by the women whose largest myoma had a diameter ≥5cm. The number of myomas did not have a significant influence on the dysmenorrhea intensity. The three types of pain (premenstrual, menstrual, and/or during sexual intercourse) had moderate pairwise correlations (ρ values from 0.304 to 0.542) that were all statistically highly significant (p<0.001). ConclusionMyoma-associated pain is, alongside hypermenorrhea, the most frequent problem reported by the affected patients. Unlike premenstrual pain and pain during sexual intercourse, the intensity of menstrual pain is clearly dependent on the location and size of the largest myoma. Further research is needed to better understand the degree to which the pain reported by the patients is due to features of the myomas versus other possible factors.

Current Treatment Approaches of Uterine Fibroids

Myoma uteri are the most common benign uterine tumors among women of reproductive age . These benign tumors are a public health problem worldwide. There are many options for the treatment of uterine myoma. Place in medical treatment of uterine myoma treatment is limited due to side effects and drug costs. Medical treatment is usually used temporary in the form of before surgery. Surgical treatment of uterine myoma should be individualized according to patient age,size and location of myoma. Treatment with interventional radiological methods of uterine myoma is not common for the moment. Such as the lack of risk associated with surgery,shorter time to return to normal life are advantages of interventional radiological methods.

The challenge of preoperative identification of uterine myomas: Is ultrasound trustworthy? A prospective cohort study.

To correlate preoperative ultrasound examination with intraoperative and anatomo-pathological findings, including estimation of number, localization and size of uterine myomas, uterine diameters and volume. A prospective study on 126 women undergoing surgery for uterine myomatosis at Campus Bio-medico between May 2013 and April 2014. The patients were divided into two groups: one submitted to hysterectomy and the other submitted to open myomectomy. Ultrasound scans were performed 1day before surgery by the same expert sonographer. The number of myomas at ultrasound was compared to intraoperative visualization and anatomo-pathological findings. Wilcoxon Test was applied to compare data registered with each technique. There was no significant difference between the number of myomas recorded at visualization and at ultrasound, while there was a significant difference between visualization and anatomo-pathology (p=0.0006). The analysis showed a non-significant difference between myoma number at ultrasound and at anatomo-pathology in the two groups, if the number of myomas was less than or equal to six. Contrarily, we observed a significant difference if the number of myomas was more than six (p=0.003). Our data show that ultrasound has limits in identifying the exact number of uterine myomas. This mapping is particularly needed in a minority of patients with usually desiring fertility who need a debulking procedure due to the large size and/or number of myomas or myoma location causing symptomatology. In patients with more than six myomas, voluminous uterus, a second-level examination such as Magnetic Resonance may be helpful.