Multiple Myomas Research Articles

How Can We Avoid the Conversion of Laparoscopic Myomectomy to Lapotomy for Large Multiple Myoma?

Study ObjectiveTo evaluate the efficacy of blunt dissection of large multiple myomas through the laparoscopy.DesignProspective research.SettingEun's gynecological laparoscopic hospital, South KoreaPatients1417 patients who had laparoscopic myomectomy for multiple large myomatas from 1st Jan. 2004-31st, Dec. 2010.InterventionHyperdiluted vasopressin is infiltrated,and large incision was made avoiding injury of uterine artery near to adnexa. We never use myoma screw and coagulate vessels like conventional myomectomy. Peeling off and blunt dissection of myoma elevating it from the bottom make laparoscopic myomectomy bloodless. Remained, supplying vessels and myometrium were sutured in 2-3 layers with 1.0 monocryl continuously. Seromuscuar layer was sutured widely to prevent the myometrium from slipping down aside.Measurements and Main ResultsTabled 1Characteristics of patients in studyCharacteristicsMean number ± SD (range)Number of removed myoma7.58±11.38(1∼105)weight of myoma320.07±280.30g(75∼3000g)largest diameter of myoma7.9±2.56cm(5∼40cm)operation time110.57±50.83mins(30∼300mins)blood transfusion0.32±0.99pints(0∼6pints) Open table in a new tab Tabled 1Complictions of laparoscopic myomectomycomplications in studypatients (%)Fever(higher than 38°: after postop.3rd ds)56(4)Infection(more than 10000:after postop.3rd ds)40(2.8)Hematoma (detected after postop.7th ds)27(1.9)Ureteral injury3(0.2)Bowel injury3(0.2)Reoperation0conversion to laparotomy0 Open table in a new tab ConclusionIf we estimate the size and number of myoma well, laparoscopic myomectomy will be performed without conversion to laparotomy emergently since we dissect them bluntly with srtong poles without trauma of surrounding vessels and then suture fast and easily regardless of location of it. Study ObjectiveTo evaluate the efficacy of blunt dissection of large multiple myomas through the laparoscopy. To evaluate the efficacy of blunt dissection of large multiple myomas through the laparoscopy. DesignProspective research. Prospective research. SettingEun's gynecological laparoscopic hospital, South Korea Eun's gynecological laparoscopic hospital, South Korea Patients1417 patients who had laparoscopic myomectomy for multiple large myomatas from 1st Jan. 2004-31st, Dec. 2010. 1417 patients who had laparoscopic myomectomy for multiple large myomatas from 1st Jan. 2004-31st, Dec. 2010. InterventionHyperdiluted vasopressin is infiltrated,and large incision was made avoiding injury of uterine artery near to adnexa. We never use myoma screw and coagulate vessels like conventional myomectomy. Peeling off and blunt dissection of myoma elevating it from the bottom make laparoscopic myomectomy bloodless. Remained, supplying vessels and myometrium were sutured in 2-3 layers with 1.0 monocryl continuously. Seromuscuar layer was sutured widely to prevent the myometrium from slipping down aside. Hyperdiluted vasopressin is infiltrated,and large incision was made avoiding injury of uterine artery near to adnexa. We never use myoma screw and coagulate vessels like conventional myomectomy. Peeling off and blunt dissection of myoma elevating it from the bottom make laparoscopic myomectomy bloodless. Remained, supplying vessels and myometrium were sutured in 2-3 layers with 1.0 monocryl continuously. Seromuscuar layer was sutured widely to prevent the myometrium from slipping down aside. Measurements and Main ResultsTabled 1Characteristics of patients in studyCharacteristicsMean number ± SD (range)Number of removed myoma7.58±11.38(1∼105)weight of myoma320.07±280.30g(75∼3000g)largest diameter of myoma7.9±2.56cm(5∼40cm)operation time110.57±50.83mins(30∼300mins)blood transfusion0.32±0.99pints(0∼6pints) Open table in a new tab Tabled 1Complictions of laparoscopic myomectomycomplications in studypatients (%)Fever(higher than 38°: after postop.3rd ds)56(4)Infection(more than 10000:after postop.3rd ds)40(2.8)Hematoma (detected after postop.7th ds)27(1.9)Ureteral injury3(0.2)Bowel injury3(0.2)Reoperation0conversion to laparotomy0 Open table in a new tab ConclusionIf we estimate the size and number of myoma well, laparoscopic myomectomy will be performed without conversion to laparotomy emergently since we dissect them bluntly with srtong poles without trauma of surrounding vessels and then suture fast and easily regardless of location of it. If we estimate the size and number of myoma well, laparoscopic myomectomy will be performed without conversion to laparotomy emergently since we dissect them bluntly with srtong poles without trauma of surrounding vessels and then suture fast and easily regardless of location of it.

How Can We Avoid the Conversion of Laparoscopic Myomectomy to Laparotomy for Large Multiple Myoma?

How Can We Avoid the Conversion of Laparoscopic Myomectomy to Laparotomy for Large Multiple Myoma?

Single layer uterine closure in laparoscopic myomectomy

ObjectiveOur goal was to assess uterine rupture in subsequent pregnancy following single layer closure during laparoscopic myomectomy (LM).DesignData was collected from Reproductive Associates of Delaware/RAD for those patients who underwent LM from December 2003 to August 2009. At this practice, single layer myometrial closure is uniformly performed by an experienced laparoscopist. Women were included if they had undergone LM requiring the use of suture and had a subsequent viable pregnancy (greater than 24 weeks).Materials and MethodsBilling records were searched for the diagnostic code for LM. Operative reports were reviewed to confirm the use of suture, and pregnancy outcome data was collected.ResultsOf 164 women who had myomectomies which met inclusion criteria, outcome data on 76 pregnancies was collected. Ten women had undergone previous myomectomy. The mean size of myoma removed was 40.4mm. The mean number of myoma removed was 3.83; 46 patients underwent removal of multiple myoma. Of 76 pregnancies, 19 were delivered vaginally and 57 were delivered by cesarean section. No uterine ruptures were reported.ConclusionBased on our case series and other data in the literature, we believe that appropriate and complete myometrial closure can be safely achieved through a single layer, when done by an experienced laparoscopist.Reproductive Associates of Delaware/RAD ObjectiveOur goal was to assess uterine rupture in subsequent pregnancy following single layer closure during laparoscopic myomectomy (LM). Our goal was to assess uterine rupture in subsequent pregnancy following single layer closure during laparoscopic myomectomy (LM). DesignData was collected from Reproductive Associates of Delaware/RAD for those patients who underwent LM from December 2003 to August 2009. At this practice, single layer myometrial closure is uniformly performed by an experienced laparoscopist. Women were included if they had undergone LM requiring the use of suture and had a subsequent viable pregnancy (greater than 24 weeks). Data was collected from Reproductive Associates of Delaware/RAD for those patients who underwent LM from December 2003 to August 2009. At this practice, single layer myometrial closure is uniformly performed by an experienced laparoscopist. Women were included if they had undergone LM requiring the use of suture and had a subsequent viable pregnancy (greater than 24 weeks). Materials and MethodsBilling records were searched for the diagnostic code for LM. Operative reports were reviewed to confirm the use of suture, and pregnancy outcome data was collected. Billing records were searched for the diagnostic code for LM. Operative reports were reviewed to confirm the use of suture, and pregnancy outcome data was collected. ResultsOf 164 women who had myomectomies which met inclusion criteria, outcome data on 76 pregnancies was collected. Ten women had undergone previous myomectomy. The mean size of myoma removed was 40.4mm. The mean number of myoma removed was 3.83; 46 patients underwent removal of multiple myoma. Of 76 pregnancies, 19 were delivered vaginally and 57 were delivered by cesarean section. No uterine ruptures were reported. Of 164 women who had myomectomies which met inclusion criteria, outcome data on 76 pregnancies was collected. Ten women had undergone previous myomectomy. The mean size of myoma removed was 40.4mm. The mean number of myoma removed was 3.83; 46 patients underwent removal of multiple myoma. Of 76 pregnancies, 19 were delivered vaginally and 57 were delivered by cesarean section. No uterine ruptures were reported. ConclusionBased on our case series and other data in the literature, we believe that appropriate and complete myometrial closure can be safely achieved through a single layer, when done by an experienced laparoscopist.Reproductive Associates of Delaware/RAD Based on our case series and other data in the literature, we believe that appropriate and complete myometrial closure can be safely achieved through a single layer, when done by an experienced laparoscopist.

Highly effective method for myoma excision and suturing in laparoscopic myomectomy

Laparoscopic myomectomy rather than abdominal myomectomy has been well documented as a treatment option for uterine myomas. However, laparoscopic myomectomy has serious limitations in two of its steps: excision of myoma with strong traction and suturing of the uterine defect. These steps are a challenge even for experienced surgeons. The authors introduce a simple but highly effective technique for excision of myoma and suturing using standard instrumentation in laparoscopic myomectomy. After incision of the myometrium, the myoma pseudocapsule is separated by insertion of the dissector tip and scissors into the myoma. After completion of myoma enucleation, the surgeon makes a U-shaped hole of suture material with forceps for an interlocking suture, and the first assistant holds the stitch to maintain the suture tension throughout the repair. From February 2010 to August 2010, 43 patients with a diagnosis of uterine myoma underwent laparoscopic myomectomy by single surgeon using the aforementioned procedure. The mean diameter of the myoma was 6.3 cm (range, 4-9 cm), and multiple myomas were observed in 19 cases (44.2%). As a result, the mean operative time was 75.9 min (range, 35-155 min), and the hospital stay was 2.7 days (range, 2-5 days). The blood loss was 137.2 ml (range, 50-250 ml), and the hemoglobin decline on the first day after surgery was 1.5 mg/dl (range, 0.1-3.6 mg/dl). Postoperative fever higher than 37.7°C was the most commonly observed morbidity (ten patients, 23.3%). How- ever, no cases had conversion to laparotomy or major complications requiring reoperation or readministration during the mean follow-up period of 5.9 months (range, 3-9 months). Laparoscopic myomectomy can be performed easily and effectively by forceps insertion and continuous interlocking suture using standard instruments.

Myomectomy before IVF: Which fibroids need to be removed?

Abstract The decision to do a Myomectomy before and IVF cycle is not an easy one. You will always be faced with the “Do you think it is essential, doctor?” question. To answer this question you have to have clear-cut evidence that this woman will not get pregnant following an IVF cycle except if she had a Myomectomy. Or if she gets pregnant, she will probably lose her baby because of the fibroids her uterus carries. We have to deploy proper judgment in each individual case based on the age as well as the number and size of the intramural myomas. A single myoma of 4cm size or less that is not encroaching on the cavity in a woman in her late thirties may deserve a single trial to get pregnant through IVF without Myomectomy. If that fails or ends in a miscarriage, she may be counseled for surgery before the second trial. However, larger and multiple myomas, especially in a younger patient may deserve surgery before enrolling her in her first IVF cycle. Single sub-serous myomas of sizes less than 5cm may well be ignored and the patient is allowed to go through IVF. However, if larger or associated with intramural myomata, surgery may be considered prior to enrolling her in an IVF cycle.

Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

BackgroundStereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied.Case PresentationA 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up.ConclusionsCCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.

Hysteroscopic Myomectomy: An Effective and Minimally Invasive Surgical Option for Submucous Myoma

Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy.Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy.Setting: Tertiary care center.Patients: Forty patients with submucosal uterine myoma.Intervention: Hysteroscopic myomectomy.Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25).Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility. Study Objective: Hysteroscopic myomectomy is a minimally invasive technique for treatment of submucous myomas. It averts need for laparotomy, reduces morbidity and hospital stay considerably and improves conception in patients with infertility. To assess the safety and effectiveness of submucous myomectomy. Design: Retrospective study of forty patients undergoing hysteroscopic myomectomy. Setting: Tertiary care center. Patients: Forty patients with submucosal uterine myoma. Intervention: Hysteroscopic myomectomy. Measurements and Main Results: The indication for surgery were infertility in 25 (62.5%), menorrhagia in 14 (40%) and recurrent abortions in 1 (2.5%). Twenty-eight (70%) patients had single myoma and 12 (30%) had multiple myoma. Size of myoma varied from 3 x 3cm to 20 x20cm. Most (28, 70%) of the myoma were arising from fundus of the uterus, 3(7.5%) from anterior wall, 5(12.5%) from posterior wall and 4 (10%) from the side wall of the uterus. Twenty one (52.5%) myomas were confined to endometrium, 14 (35%) were infiltrating myometrium less than 50% and 5(12.5%) were infiltrating more than 50%. Four (10%) patients received preoperative uterine preparation (danazol in 2: GnRH analogues in 2). Procedure could be performed in single sitting in all except one (39, 97.5%). Laparotomy was needed in two patients (those with myoma infiltrating >50% of myometrium). None required blood transfusion. There was no perioperative or postoperative complication. All except two (95%) were discharged within 24 hrs. On follow up menorrhagia was persistent in 4 patients. One (2.5%) had recurrence of myoma. Conception rate in patient with infertility was 60% (15/25). Conclusion: Hysteroscopic myomectomy is safe and effective surgical option for submucous myoma in women presenting with abnormal uterine bleeding and infertility.

Laparoscopic Morcellation In-Situ for Multiple Myomas and Adhesion Barrier Application

Laparoscopic myomectomy is a safe and reliable procedure, even in the deep intramural large and multiple myomas using three ancillary ports. The myometrium was injected with vasopressin and local electorcauterization for hemostastasis and minimize blood loss during surgical procedures going on. Morcellation insitu was performed for complete removal of the myomas. The deep myometrium was sutured one or two layers with 1-0 Monocryl. The superficial myometrium and serosal were sutured with 2-0 monocryl.

Uterine Arteries Temporary Occlusion during Laparoscopic Myomectomy

To demonstrate the topographic anatomy and the surgical technique applied to perform the uterine artery temporary occlusion during laparoscopic myomectomy. Patient: Female, 41 years old, no previous pregnancy, complaining of menorrhagia and pelvic pain. Clinical investigation with Tranvaginal ultrasonography and MRI identified multiple myomas in a hyper vascularized utherus. Results: A step-by-step surgical procedure was performed.Laparoscopic surgery with anatomical retroperitoneal dissection and temporary uterine arteries occlusion was performed. Conclusion: Temporary uterine artery occlusion can be used to reduce intraopeative bleeding and allow minimally invasive treatment of multiple myomas.

Laparoscopic Intracapsular Myomectomy: Comparison of Single Versus Multiple Fibroids Removal. An Institutional Experience

The aim of this study was to compare single versus multiple laparoscopic myomectomy with an intracapsular method. A total of 335 laparoscopic intracapsular myomectomies were compared. They were subdivided into two groups. Group I included 195 patients with myoma; group II, 140 patients with multiple myomas, 4-9 cm in diameter. Laparoscopic procedures were compared with respect to intraoperative complications, postoperative compliance, and general surgical feedback. Results were analyzed using SAS software (version 8), considering a P-value of <0.05 as significant. No differences (P>0.05) between groups were observed with respect to the following: intraoperative blood loss (98 ± 4.7 mL of group I versus 106 ± 6.8 mL of group II), catheter inside pelvis for postsurgical drainage (40% versus 36.4% women), analgesic administration for the first 24 hours (41.5% versus 40% patients), postoperative fever after 24 hours (11.2% versus 9.2% women), postoperative therapeutic antibiotics administration (8.2% versus 6.4% patients), and hospitalization and postoperative ultrasound (US) intramyometrial hematoma detection (6.6% versus 5.7% of group II). The only surgical statistical difference (P<0.05) was in the mean total laparoscopic time (60 ± 7.2 minutes for group I versus 97 ± 8.9 minutes for group II). Intracapsular laparoscopic myomectomies, performed in the same session on a single or on multiple fibroids, seem to preserve myometrial integrity and allow the restoration of uterine scar, with few early and late surgical complications.

Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases

The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained post-operative death. Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas.

Outcomes of incomplete hysteroscopic resection of sessile type submucous myoma

Study Objective: To analyze the progression of patients after incomplete TCR (transcervical resection), including natural regression, pregnancy and repeated surgery.Setting: Numazu City Hospital, Shizuoka, JapanPatients: From 2005 to 2008, hysteroscopic myomectomy was performed on 21 patients with sessile type submucous myoma. Thirteen of these cases underwent an incomplete resection, and the follow up period after which post TCR occurred in these cases was between 5 to 26 months. Of 13 cases, 9 patients had a single myoma, and 4 had multiple myomas. Results: Of 9 cases of a single myoma, 2 regressed spontaneously within 4 months postoperatively. Four cases remained stable. Three cases required another surgery, including TCR. The sizes of the persistent myomas were 13 to 19.5 mm, 13 to 18 mm, and 20 to 38 mm, respectively. Based on our results between stable and repeated surgery groups, the border size of a myoma was 20 mm. Both a patient with a regressed myoma and 1 with a stable myoma became spontaneously pregnant. Of 4 cases with multiple myomas, 2 cases remained stable and another 2 cases likely needed another surgery. The number of myomas in stable cases was 2, while the number of myomas that required another intervention was 7 and innumerable. Therefore, the border number of a myomas was 2. Conclusion: Our results indicate that patients with persistent myomas that are single in number and smaller than 2 cm in size may be able to become pregnant and that these myomas may spontaneously regress. This study also showed that additional surgical intervention might be necessary for the persistent single myoma that is bigger than 2 cm or multiple myomas of more than 3 in number.

Office Endometrial Ablation with Local Anesthesia Using the HydroThermAblator System: Comparison of Outcomes in Patients with Submucous Myomas with Those with Normal Cavities in 246 Cases Performed Over 5½ Years

Study Objective To estimate the safety and efficacy of the HydroThermAblator (HTA) system for performance of endometrial ablation in the medical office setting using local anesthesia and minimal oral sedation and to compare results obtained in patients with submucous myomas with those in patients with normal endometrial cavities. Design Retrospective cohort analysis of 246 HTA procedures (Canadian Task Force classification II-2). Setting Medical offices of a suburban community medical center that is part of a large health maintenance organization. Patients Two hundred forty-six women aged 28 to 63 years (mean [SD], 45.1 [6.0] years) with abnormal uterine bleeding unresponsive to conservative management, including 104 patients (42.3%) with submucous myomas. Type 0 or type I myomas were present in at least 86 patients with submucous myomas (82.7%) and ranged from 1 to 4 cm in greatest diameter. In the other 18 patients, submucous myomas were not classified by type. Patients were evaluated at 2 to 70 months after the procedure (median follow-up, 31.0 months). Three patients were lost to follow-up, and 12 patients underwent hysterectomy for indications other than abnormal bleeding and were excluded from the analysis. Thus, 231 patients were included in the analysis. Interventions Endometrial ablation was performed using the HTA system with paracervical or intracervical block after oral premedication with ibuprophen, diazepam, and acetominophen or hydrocodone and intramuscular ketorolac. No intravenous or intramuscular narcotics were used. The anesthesia regimen was the same in patients with submucous myomas as in those with normal cavities, and the procedure was performed in exactly the same manner. All procedures were performed in the medical office procedure room by 7 board-certified gynecologists; most procedures were performed by the authors. Measurements and Main Results Of the 231 patients included in the analysis, 121 (53.4%) reported postablation amenorrhea, 62 (26.8%) reported light menses or spotting, 21 (9.1%) reported normal menses, 15 (6.5%) reported menorrhagia, and 12 (5.2%) underwent hysterectomy because of bleeding. In the 136 patients with normal cavities, amenorrhea was achieved in 84 patients (61.8%), oligomenorrhea in 35 (25.7%), and eumenorrhea in 12 (8.8%). Four patients (2.9%) continued to have menorrhagia requiring medical treatment. In the 95 patients with submucous myomas, amenorrhea was reported by 37 patients (38.9%), oligomenorrhea by 27 (28.4%), eumenorrhea by 9 (9.5%), and menorrhagia by 11 (11.6%). In 11 patients (11.6%), hysterectomy was performed because of menorrhagia. All patients who underwent hysterectomy had multiple myomas, and 9 (81.8%) also had adenomyosis. The failure rate, defined as patients with menorrhagia or undergoing hysterectomy because of bleeding, was 11.7% overall. The failure rate in patients with submucous myomas and normal cavities was 23.2% and 3.7%, respectively (relative risk, 6.3; 95% confidence interval, 2.5–16.0). While the failure rate in the group with myomas was statistically significantly higher than in the group without myomas, the failure rate in the myoma group was still comparable to that achieved using electrosurgical resection and ablation of similar types of myomas as reported in the literature. The amenorrhea rate achieved in the myoma group (38.9%) was also comparable to that achieved in US Food and Drug Administration pivotal trials in patients with normal cavities treated using all of the nonhysteroscopic global ablation devices as well those treated using rollerball endometrial ablation. The rate of hysterectomy because of bleeding was 5.2% overall. The hysterectomy rate in patients with submucous myomas and normal cavities was 11.6% and 0.7%, respectively. Only 1 procedure was discontinued (at 8 minutes) because of pain. Four patients had postoperative endometritis, with 2 requiring hospitalization for intravenous antibiotic therapy. Two false passages were created while dilating the cervix, with subsequent inability to perform the procedure. Conclusions Hydrothermablation performed in the medical office using local anesthesia seems to be a safe, effective, and cost-saving procedure for treatment of abnormal uterine bleeding in women with both normal and myomatous uteri. Although the success rate in patients with normal cavities was higher than that achieved in patients with submucous myomas, hysterectomy because of abnormal bleeding related to myomas was avoided in 88.4% of the group with myomas.

Are ultrasonographic myoma characteristics associated with blood loss at delivery?

The presence of myomas in pregnancy is associated with greater blood loss at delivery. The aim of this study was to evaluate whether the sonographic characteristics of myomas can predict blood loss at delivery in women with large myomas. Among women who underwent second-trimester ultrasound screening at our department between January 1996 and December 2004, 251 had at least one myoma with a mean diameter > or = 5 cm. Number of myomas (single vs. multiple), maximum diameter of the largest myoma, sum of the maximum diameter of each myoma, change in size of myomas between first and last scan, and location in relation to the placenta and to the presenting part of the fetus (above or below) were analyzed in relation to blood loss at delivery and severe postpartum hemorrhage (> or = 1000 mL). Multivariate analysis showed that the presence of multiple myomas was the only parameter independently associated with amount of blood loss at delivery (P = 0.003). The association between the presence of multiple myomas and severe postpartum hemorrhage was of borderline significance for the statistical power of this study (P = 0.08). In women with large myomas, the presence of multiple tumors is independently associated with heavier blood loss at delivery but not with postpartum hemorrhage of > or = 1000 mL.

Surgery‐assisted reproductive technology hybrid therapy: A reproductive procedure for an infertile woman of late reproductive age with multiple myomas

To produce a successful pregnancy in a 38-year-old infertile patient with relapsed myoma using a technique we refer to as 'surgery-assisted reproductive technology (ART) hybrid therapy' because it combines ART for cryopreservation of in vitro fertilized eggs with reproductive surgery. A 38-year-old nulliparous woman who had undergone abdominal myomectomy and in whom magnetic resonance imaging showed multiple myomas was treated at our University-affiliated hospital and outpatient clinic. Blastocysts were cryopreserved during the preoperative period. Laparoscopic myomectomy was performed after preoperative treatment with a GnRH agonist. Ten months after the operation, the youngest cryopreserved blastocyst was transferred into the uterus and implanted successfully. Treatment resulted in successful implantation and pregnancy. In January 2008, the course of pregnancy had been uneventful and the patient gave birth to a male infant weighing 2998 grams by cesarean section at 37 weeks of gestation. We have treated eight patients using hybrid therapy with encouraging results, and we describe these cases herein briefly.

Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

not complain while some suffer debilitating symptoms from very small myomas. The pathogenesis of myomas is ill understood though it is well known that multiple myomas in the same uterus are derived from individual myometrial cells and not through a metastatic process.6 Myoma growth is hormone dependent explaining why they are rare prior to menarche and regress after the menopause. This is the time when sex steroids mainly estrogens and progesterone are at their lowest. Studies have found that estrogen and progesterone receptors are over expressed in myoma tissues compared to other normal myometrial tissue.7 Uninterrupted estrogen supply encourages myoma growth; however growth is interrupted in low levels as in smokers and pregnancy. Growth may at times be excessive in pregnancy. This is explained by increased blood flow to the uterus during pregnancy.8 The main symptoms which make patients visit their doctors are: 1. Abnormal uterine bleeding 2. Pressure 3. Pelvic/abdominal pains 4. Rapid growth 5. Infertility 6. Repeated abortions. Management of fibroids is varied and may depend on the physician the patient visits first. This can be medical or surgical. Medical treatment uses GnRH analogues which produce an estrogen deficient milieu thereby reducing the symptoms of the patient. Unfortunately for the medical treatment, it cannot be offered over a long time. It is therefore used while waiting for the patient to make up their mind through proper counseling. GnRH analogues help reduce the size of myomas enabling easy surgery or building up of the hemoglobin levels of the patient before surgery.9-11 Myomectomy or hysterectomy are the other treatment modes a patient with symptomatic fibroids is offered. Hysterectomy is usually proposed to those who might have completed their family size while, myomectomy is proposed for those who for one or other reason (fertility or personal) would want to keep their uterus. A patient should also be educated to help her or together with her spouse to make an informed decision. Abstract

Progressive formation of uterine arteriovenous fistula after laparoscopic-assisted myomectomy

Laparoscopic-assisted myomectomy (LAM) is a minimally invasive procedure with many advantages. However, progressive formation of uterine arteriovenous fistula (AVF) after LAM is not described as a significant complication. A 39-year-old nulligravida underwent LAM for multiple myomas. On ultrasonography obtained 13 days after LAM, a prominent vascular mass was identified in the post-myomectomy scar. Computed tomographic angiography showed AVF originating from the left uterine artery. Uterine AVF was endovascularly embolized by metallic coils to avoid future hemorrhage. Development of uterine AVF after LAM is a potentially life-threatening complication. Early diagnosis and endovascular management can provide a significant benefit for a woman wishing uterine preservation.

A cornual ectopic pregnancy case: diagnosis, etiology and its management

This is a report of a case of cornual ectopic pregnancy, with transvaginal ultrasonography done for early detection, screening, β-hCG measuring, also discussed was the role of methotrexate therapy prior to operative procedure with conservative management. Multiple intramural myomas (22 myomas) in this case were strongly believed as the etiology of the cornual pregnancy. (Med J Indones 2008; 18: 64-8) Keywords: Cornual ectopic pregnancy, multiple myomas, ultrasonography, methotrexate

Leiomyosarcoma In A Young Adult

A 35 years old woman of infertility with multiple myomas underwent myomectomy with tubal reconstructive surgery . There was difficulty in enucleating one of the myoma which was diagnosed on histopathology as leiomyosarcoma.

The Digging and Peeloff Method (DP Method) by Using the Blunt-Tip Steel Pole of the Myomatous Mass through the Laparoscopic Myomectomy

To get complete laparoscopic myomectomy on reducing blood loss and conserving endometrial continuity. Design: Prospective analysis of 863 cases of laparoscopic myomectomy from 1, Jan, 2002 to 31, Oct, 2007. Setting: Eun's hospital in Gwang-ju, South Korea Patients: 863 women with large (5cm∼22cm, 71gm∼1000gm) or/and multiple (3∼32 numbers) myoma. Intervention: Peeling off and digging myometrium surrounding myoma with blunt-tip steel poles and then continuos suturing for 3∼4 layers with the 0 vicryal.