Symptomatic Uterine Leiomyomas Research Articles

Clinical and molecular risk factors for repeat interventions due to symptomatic uterine leiomyomas

BackgroundRepeat leiomyoma occurrence or even reintervention is common after myomectomy. Little is known about the factors related to repeat interventions. ObjectivesThis study aimed to determine the frequency of leiomyoma-related reintervention after an initial laparoscopic or abdominal myomectomy and to analyze both clinical and molecular risk factors for reinterventions. Another objective was to define the frequency of clonally related tumors from repeat operations. Study DesignThis retrospective cohort study included 234 women who had undergone laparoscopic or abdominal myomectomy in 2009-2014. Information on repeat leiomyoma-related interventions as well as on other clinical factors was collected from medical records after a median follow-up time of 11,4 years (range 7,9-13,8 years) after the index procedure. The effect of clinical risk factors on the risk of reintervention was analyzed by the Kaplan-Meier estimator and the Cox proportional hazards model. For molecular analyses, we examined the mutation profiles of 133 formalin-fixed paraffin-embedded leiomyoma samples from 33 patients with repeat operations. We screened the tumors for the three primary leiomyoma driver alterations—MED12 mutations, HMGA2 overexpression, and FH-deficiency—utilizing Sanger sequencing and immunohistochemistry. To further assess the clonal relationship of the tumors, we executed whole-exome sequencing for 52 leiomyomas from 21 patients who exhibited the same driver alteration in tumors obtained from multiple procedures. ResultsReintervention rate at 11,4 years after myomectomy was 20% (46/234). Number of leiomyomas removed at the index myomectomy was a risk factor (hazard ratio 1.21; 95% confidence interval 1.09-1.34). Age at index myomectomy (hazard ratio 0.94; 95% confidence interval 0.89-0.99) and postoperative parity (hazard ratio 0.23; 95% confidence interval 0.09-0.60) were protective factors. Molecular characterization of tumors from index and non-index operations confirmed a clonal relationship of the tumors in 3/33 (9%) patients. None of the leiomyomas harboring a MED12 mutation —the most common leiomyoma driver— were confirmed clonally related. FH-deficiency was detected in repeat leiomyomas from 3/33 (9%) patients. All these patients harbored a germline FH mutation, which is distinctive for the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. Finally, we identified three (3/33; 9%) patients with two tumors each displaying somatic mutations in a recently identified novel leiomyoma driver gene, YEATS4. All YEATS4 mutations were different and thus the tumors were not clonally related. ConclusionOur study shows that reintervention is common after surgical myomectomy. Uterine leiomyomas typically develop independently, but some share a clonal origin. Repeat leiomyoma occurrence may be due to genetic predisposition, such as a germline FH mutation. Distinct somatic YEATS4 mutations identified in multiple leiomyomas from the same patient indicate a possible role for YEATS4 in repeat leiomyomas.

Myolyse des fibromes utérins par radiofréquence cœlioscopique sous contrôle échographique : à propos d’une série rétrospective

ObjectiveTo assess clinical and radiological efficacy and safety of laparoscopic ultrasound-guided radiofrequency ablation of uterine leiomyomas. Material and MethodsThirty-three patients with symptomatic uterine leiomyomas FIGO type 2 to 7, have undergone a laparoscopic ultrasound-guided radiofrequency ablation at Croix Rousse University Hospital Center (Hospices civils de Lyon) and at Saint-Vincent de Paul Hospital in Lille, between June 2020 and December 2022. The characteristics of each myoma and the symptoms were assessed with pelvic MRI and with Higham score, SSS and HRQL scores preoperatively and at 6 months. ResultsA total of 54 fibroids have been treated in 33 patients. We observed a significant decrease of the volume 6 months after the surgery, on average 21mL (55.97 vs. 74.37mL, 95% CI [7.13–34.88], P=0.001). The maximum diameter of each fibroid was also significantly reduced on average 11.78mm (41.89 vs. 52.06, 95% CI [8.83–14.73], P<0.05). We noticed a significant decrease of the NRS for dysmenorrhea on average 2.79 points (2.1 vs. 4.89, 95% CI [1.14–4.42], P<0.05). There was also a trend to improvement of menorrhagia, assess by Higham score. Indeed, 70.8% of the patients had menorrhagia. Menorrhagia was improved of 108,3 points with an average Higham score before surgery of 197.3 versus 87.9 after surgery (95% CI [47.9–168.8], P=0.001). Concerning UFS-QOL score: the symptom severity score (SSS) decreased on average 33 points, testifying of symptom improvement (27.04 vs. 60.89, 95% CI [22.92–43.39], P<0.001) and the HRQL score increased on average 20 points testifying quality of life improvement (65.57 vs. 42.7, 95% CI [15.83–37.85]. P<0.001). No severe adverse event has been reported. ConclusionIn this first French study about radiofrequency ablation. We confirm its efficiency for improvement of symptoms and quality of life but other study is mandatory to confirm the safety of this procedure in particular in patients with a wish to conceive.

Outcome prediction for symptomatic patients with fibroids who underwent uterine artery embolization

PurposeTo predict the clinical outcome of symptomatic patients with uterine leiomyomas who underwent uterine artery embolization (UAE), based on clinical and radiological features. MethodsPatients with symptomatic uterine leiomyomas who underwent UAE from March 2010 to September 2019 were consecutively included in this retrospective study. Patients with persistent or recurrent symptoms and those who needed repeated UAE, myomectomy, or hysterectomy following the initial treatment were considered to have a poor outcome after UAE. The total and enhancing volume of the dominant leiomyoma in each location and uterine volume were obtained before and after UAE. Univariate and multivariate Cox proportional hazard analyses were used to evaluate the parameters that could predict poor outcome. ResultsA total of 116 patients (mean age, 45 ± 5 years) were included. Forty-six patients (46/116, 39.7%) showed poor outcome. Cox regression analysis showed higher hazard of poor outcome for younger patients vs. older patients (HR: 0.92, p-value: 0.01), patients with adenomyosis vs. patients without adenomyosis (HR: 2.47, p-value < 0.01), patients with adenomyosis thickness > 2.5 cm before UAE vs. patients without adenomyosis (HR: 4.2, p-value < 0.01) and for patients with intramural fibroid enhancement volume > 440 cm3 compared to patients with no intramural fibroids (p-value: 0.06). Multivariate Cox regression analysis including age, the thickness of adenomyosis, and intramural leiomyoma volume of enhancement before UAE was chosen as the best model to predict the outcome. ConclusionsPretreatment clinical and MRI features could identify patients with a higher risk for poor outcome after UAE.

The Association Between Uterine Leiomyoma and Hypertension: A Single Center Case-Control Study

Background: Cardiovascular Diseases (CVD), mainly Hypertension (HTN), is the leading cause of death among women. Uterine Leiomyomas (UL) which have been associated with hypertension in multiple studies, may be a female-specific risk factor. Fibroids have become a primary reason for myomectomy and hysterectomy, nowadays. This study aims at the relationship between HTN and fibroids.&#x0D; Methods: This case-control study was conducted on patients with symptomatic UL, scheduled for surgery. Patients were studied based on Blood Pressure (BP), the number and size of fibroids, past medical conditions, and gynecological history.&#x0D; Results: Four hundred patients, divided into two groups of control and case, were studied. Menometrorrhagia was the most common reason for referral in both groups (328 patients in general). The use of Oral Contraceptives (OCP) (12 vs. 5%), anemia (57 vs. 38.5%), history of infertility (11.5 vs. 3.5%), and abortion (38.5 vs. 22%) was significantly higher in patients with fibroids. 24% of patients with fibroid suffered from hypertension; which was higher in comparison to the control group (9%). Patients with UL were 4.9 times in danger of having HTN.&#x0D; Conclusion: UL is associated with hypertension. It is also concluded that anemia, rate of abortion, and infertility are higher in patients with UL.

Increased Occurrence of Cutaneous Leiomyomas and Dermatofibromas in Patients with Uterine Leiomyomas without Fumarate Hydratase Gene Mutations.

Leiomyomas are smooth muscle-derived benign neoplasms that can affect all organs, most frequently in the uterus. Fumarate hydratase gene (FH) mutation is characterised by an autosomal dominant disease with increased occurrence of renal tumours, but also by cutaneous (CLs) and uterine leiomyomas (ULs). So far, an increased occurrence of skin tumours in non-mutated patients with ULs has not been verified. To this aim, a case-group of women who were FH non-mutated patients surgically treated for ULs (n = 34) was compared with a control-group (n = 37) of consecutive age-matched healthy women. The occurrence of skin neoplasms, including CLs and dermatofibromas (DFs), was evaluated. Moreover, the microscopic features of FH non-mutated skin tumours were compared with those of an age-matched population group (n = 70) who presented, in their clinical history, only one type of skin tumour and no ULs. Immunohistochemical and in vitro studies analysed TGFβ and vitamin D receptor expression. FH non-mutated patients with ULs displayed a higher occurrence of CLs and DFs (p < 0.03 and p < 0.001), but not of other types of skin tumours. Immunohistochemistry revealed a lower vitamin D receptor (VDR) expression in CLs and DFs from the ULs group compared with those from the population group (p < 0.01), but a similar distribution of TGFβ-receptors and SMAD3. In vitro studies documented that TGFβ-1 treatment and vitamin D3 have opposite effects on α-SMA, TGFβR2 and VDR expression on dermal fibroblast and leiomyoma cell cultures. This unreported increased occurrence of CLs and DFs in FH non-mutated patients with symptomatic ULs with vitamin D deficiency suggests a potential pathogenetic role of vitamin D bioavailability also for CLs and DFs.

Histological findings in resected leiomyomas following MR-HIFU treatment, single-institution data from seven patients with unfavorable focal therapy

Purpose Magnetic resonance – high-intensity focused ultrasound (MR-HIFU) is a noninvasive treatment option for symptomatic uterine leiomyomas. Currently, pretreatment MRI is used to assess tissue characteristics and predict the most likely therapeutic response for individual patients. However, these predictions still entail significant uncertainties. The impact of tissue properties on therapeutic outcomes remains poorly understood and detailed knowledge of the histological effects of ultrasound ablation is lacking. Investigating these aspects could aid in optimizing patient selection, enhancing treatment effects and improving treatment outcomes. Methods and materials We present seven patients who underwent MR-HIFU treatment for leiomyoma followed by second-line surgical treatment. Tissue samples obtained during the surgery were stained with hematoxylin and eosin, Masson’s trichrome and Herovici to evaluate general morphology, fibrosis and collagen deposition of leiomyomas. Immunohistochemical CD31, Ki-67 and MMP-2 stainings were performed to study vascularization, proliferation and matrix metalloproteinase-2 protein expression in leiomyomas, respectively. Results The clinical characteristics and radiological findings of the leiomyomas prior to treatment as well as qualitative histological findings after the treatment are presented and discussed in the context of current literature. A tentative model for volume reduction is presented. Conclusion These findings provide insights into potential factors contributing to suboptimal therapeutic outcomes and the variability in histological changes following treatment.

8Spheres conformal microspheres as embolic agents for symptomatic uterine leiomyoma therapy in uterine artery embolization (UAE): A prospective clinical trial.

To evaluate the treatment efficacy of uterine artery embolization (UAE) using 8Spheres conformal microspheres for symptomatic uterine leiomyoma. In this prospective observational study, 15 patients were enrolled and underwent UAE by 2 experienced interventionalists from September 1, 2018, to September 1, 2019. All patients underwent menstrual bleeding scores, the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores (with lower scores indicating mild symptoms), pelvic contrast-enhanced magnetic resonance imaging, ovarian reserve tests (estradiol, prolactin, testosterone, follicle-stimulating, luteinizing, and progesterone), and other appropriate preoperative examinations within 1 week before UAE. During follow-up, menstrual bleeding scores and the symptom severity domain of the Uterine Fibroid Symptom and Quality of Life questionnaire scores were recorded at 1, 3, 6, and 12 months after UAE to assess the efficacy of symptomatic uterine leiomyoma. Pelvic contrast-enhanced magnetic resonance imaging was performed 6 months after the interventional therapy. Biomarkers of ovarian reserve function were reviewed at 6 and 12 months after treatment. All 15 patients successfully underwent UAE, without severe adverse effects. Six patients experienced abdominal pain, nausea, or vomiting, all of which improved significantly after symptomatic treatment. The menstrual bleeding scores declined from baseline (350.2 ± 61.9 mL) to (131.8 ± 42.7 mL), (140.3 ± 42.4 mL), (68.0 ± 22.8 mL), and (64.43 ± 17.0 mL) at 1, 3, 6, and 12 months, respectively. The symptom severity domain scores at 1, 3, 6, and 12 months postoperatively were significantly lower and statistically significant compared to the preoperative scores. The uterus and dominant leiomyoma volumes decreased from baseline (340.0 ± 35.8 cm3), (100.6 ± 24.3 cm3) to (266.6 ± 30.9 cm3), (56.1 ± 17.3 cm3) at 6 months after UAE, respectively. Moreover, the ratio of leiomyoma volumes and uterus decreased from (27.4 ± 4.5%) to (18.7 ± 3.9%). At the same time, there was no significant effect on changes in the biomarkers of ovarian reserve levels. Only the changes in testosterone levels before and after UAE were statistically significant (P < .05). 8Spheres conformal microspheres are ideal embolic agents for UAE therapy. This study showed that 8Spheres conformal microsphere embolization for symptomatic uterine leiomyoma could effectively relieve heavy menstrual bleeding, improve the symptom severity of patients, reduce the volume of leiomyoma, and have no significant effect on ovarian reserve function.

Complex Gynecologic Fistulas Presenting 10 Years After Uterine Artery Embolization.

Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported. This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair. Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.

Uterine Leiomyoma with Bizarre Nuclear Morphology: Report of a Rare Case

Abstract Introduction/Objective Sporadic fumarate hydratase (FH)-deficient leiomyoma occurs as a result of somatic inactivation of the FH gene and has been found to represent 1% of uterine leiomyomas. Germline inactivation of the FH gene is associated with a rare autosomal dominant syndrome known as hereditary leiomyomatosis and renal cell carcinoma (HLRCC). Women with HLRCC develop cutaneous and uterine leiomyomas and an aggressive renal cell carcinoma, with 57% reported to undergo hysterectomy at 30 years of age or younger. All FH-deficient leiomyomas display a distinct histology characterized by scattered bizarre nuclei, eosinophilic cytoplasmic inclusions, conspicuous eosinophilic nucleoli, and perinuclear clearing. Immunohistochemically, the neoplastic cells do not express FH while they are positive for S-(2-succino)-cysteine (2SC), a metabolite that accumulates when FH is inactivated. Methods/Case Report We present a 48-year-old woman who underwent supracervical hysterectomy for a symptomatic uterine leiomyoma. She was status post left salpingo-oophorectomy for left adnexal endometriosis. Grossly, the hysterectomy specimen was significant for one 8.0 cm intramural uterine corpus tumor with a tan-white whorled cut surface. Histology showed a smooth muscle neoplasm in the myometrium composed of spindled cells with abundant eosinophilic cytoplasm, occasional enlarged prominent nucleoli with perinuclear halos, intracytoplasmic eosinophilic globules, focal bizarre nuclear atypia and thin-walled staghorn vessels with widespread hyaline necrosis with no mitotic activity. Immunohistochemical studies demonstrated that the neoplastic cells expressed desmin, SMA, SMMH, and 2SC and were negative for FH; consistent with a FH-deficient leiomyoma. Results (if a Case Study enter NA) NA Conclusion Although rarely seen, pathologists should be cognizant of FH-deficient neoplasms. Genetic counseling and close follow up of the individuals harboring germline inactivating mutations of the FH gene could lead to early detection of the RCC in these patients and their family members.

The incidence of unexpected uterine malignancies in hysterectomies carried out for benign indications

PurposeThe aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics.MethodsWe conducted a retrospective review of patients who underwent benign hysterectomy in the Department of Gynecology, the First Hospital of Shanxi Medical University from January 2015 to December 2020. The clinical data of these patients were retrieved and collected.ResultsTheir median age was 49.8 years (31–82 years). The mean parity was 1.86 ± 2.54. Their mean BMI was 27.5 ± 7.6 kg/m2. 42.90% were (2438/5683) postmenopausal. The benign indications of procedure were as follows: symptomatic uterine leiomyomas 2218/5683 (39.02%), pelvic organ prolapse 1406/5683 (24.74%), symptomatic endometriosis or adenomyosis 1132/5683 (19.91%), and 927/5683 (16.31%) to treat other benign conditions such as abnormal uterine bleeding, infection, polyps, and endometrial hyperplasia without atypia. In minimally invasive surgery subgroups, 1560/2621 (59.52%) specimens were removed by in-bag manual morcellation through vaginal cuff. The mean operative time of minimally invasive surgery with in-bag morcellation was shorter than abdominal hysterectomy (96.75 ± 35.7 vs. 140 ± 32.6, P < .001), and the estimated blood loss was also less than abdominal hysterectomy (47.35 ± 42.3 vs. 170 ± 60.4, P < .001). A total of 19/5683 (0.33%) unexpected uterine malignancies were recorded, of which 14/5683 (0.26%) were unexpected endometrial carcinomas and 5/5683 (0.08%) were unexpected uterine sarcomas.ConclusionPreoperative examination in the context of benign hysterectomy must be undertaken with care, and patients should be educated about the very slight possibility of a malignant diagnosis.

POMMS: Pre-operative misoprostol in myomectomy surgery: A randomised controlled pilot study

ObjectiveTo assess the effect of pre-operative sublingual misoprostol on intra-operative blood loss in abdominal myomectomy as compared to placebo. Study designDouble-blind randomised controlled pilot study. A single tertiary Gynaecology Unit in Melbourne, Australia. Women ≥ 18 years old undergoing laparoscopic or open myomectomy. Women undergoing laparoscopic or open myomectomy for symptomatic uterine leiomyomas were randomised to pre-operative sublingual 400mcg misoprostol or placebo. Intra-operative blood loss was measured via accurate record keeping of the post-operative volume in the suction canister and weighed packs, minus any irrigation fluid used. ResultsIntraoperative blood loss in the misoprostol treatment group was 306 ml ± 281 ml, compared to 325 ± 352 ml in the placebo group; P = 0.83. Fibroid volume was a consistent predictor of intra-operative blood loss. For each 1 ml increase in fibroid volume there is an increase in blood loss by 0.26 ml (95 % CI: 0.07 – 0.46). ConclusionsIn this study, we found that there was no significant difference in blood loss between women who received and did not receive sublingual misoprostol before abdominal myomectomy. This is an exploratory study laying the foundation for further randomised clinical trials.

Uterine leiomyomas embolization with magnetic resonance imaging follow up

Introduction: Uterine artery embolization (UAE) has been used to treat symptomatic uterine leiomyomas, as women choose to preserve their uterus, uterus sparing techniques such as UAE have been developed. Magnetic resonance imaging (MRI) sequence signal characteristics and the degree of leiomyoma enhancement may be used to predict the response of leiomyoma to UAE. Objective: to investigate role of UAE in different uterine myomas with follow up by MRI. Materials and methods: This prospective observational study was included 40 females with clinical criteria of symptomatic fibroid who weren’t suitable or refuse the other modalities of treatment and underwent UAE. All patients were undergone pre-procedure pelvic ultrasound and pelvic MRI, and post-procedure pelvic MRI. Results: There was a significant decrease in the uterine volume post embolization in all patients with infarction more than 50% occurred in 38 (95%) patients. Bleeding and anemia in patients who had improved were significantly higher than those who were unchanged/recurrent (P value &lt;0.05). Post embolization syndrome occurred in 10 patients (25%), only one patient (2.5%) had puncture site hematoma, two patients (5%) complained with pelvic infection and re-bleeding occurred in 5 (12.55%) patients.

Short- and long-term evaluation of disease-specific symptoms and quality of life following uterine artery embolization of fibroids

BackgroundThe purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid.ResultsA total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical improvement from baseline to short- and long-term follow-up (p < 0.001). Patients with small fibroids showed a significantly better response to UAE in multiple subcategories of the questionnaire than patients with fibroids ≥ 10 cm who had a twofold higher probability of re-intervention in the Cox-regression model.ConclusionsUAE is an effective treatment method for symptomatic fibroids that leads to quick relief of fibroid-related symptoms with marked improvement of quality of life and is associated with a low risk for re-interventions. Patients with small fibroids tend to show a better response to UAE compared to patients with large fibroids.Trial registration Charité institutional review board, EA4/167/20. Registered 27 November 2020—Retrospectively registered. https://ethikkommission.charite.de/

Metastatic gastric adenocarcinoma to the uterine cervix—a case report and review of the literature

BackgroundPoorly differentiated diffuse-type gastric adenocarcinoma often presents at an advanced stage. While gastric cancer typically metastasizes to the liver, lung and bone, metastasis to the uterine cervix is extremely rare. To our knowledge, less than forty cases have been described in the medical literature.Case presentationWe report a case of a 47-year-old woman who presented to us with symptomatic uterine leiomyomas and subsequently underwent a successful total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The diagnosis of metastatic cancer involving the cervix was established incidentally on histopathology, which demonstrated atypical signet ring cells in the lymphovascular spaces of the cervix. Further investigations for a primary malignancy revealed a poorly differentiated diffuse-type gastric adenocarcinoma.ConclusionGastric cancer involving the uterine cervix is rare and associated with a poor prognosis. When presented with isolated cervical metastases, the gastrointestinal tract should be considered as a possible primary source. Due to the limited publications on this clinical entity, we expect to raise awareness and study this unique manifestation of gastric cancer by presenting our case.

Clinical and Patient Reported Outcomes Pre- and Postsurgical Treatment of Symptomatic Uterine Leiomyomas: A12-Month Follow-up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation (LAP-RFA) and Myomectomy

(Abstracted from J Minim Invasive Gynecol 2022; doi: 10.1016/j.jmig.2022.01.009) Uterine leiomyomas (ULs) affect a large population of women in the United States. Despite the high incidence of women with symptomatic ULs, the number of surgical procedures performed annually is fewer than 250,000.

RETROSPECTIVE STUDY FOR AGE PREVALENCE OF UTERINE FIBROIDS IN A TERTIARY CARE HOSPITAL

Background: Uterine broids, also known as Leiomyoma, are the most common benign neoplasm in the female genital tract and originate from the myometrium ́s smooth muscle. The cause of the broids is unknown, but however, it is estimated to be caused by estrogens and progestrones which proliferate tumor growth. Fibroids are seen to rarely occur before menarche and reduce after menopause. This study was carried out to know the age prevalence of uterine broids in a tertiary care hospital of Nagpur Methods: Clinical les and histopathology reports of all patients that operated for symptomatic uterine broids or leiomyomas between 2017 to 2021 were obtained from gynaecology department and histopathology department. A total 165 cases were studied. Results: Clinical les and histopathology reports of Orange city hospital Nagpur showed that total 165 patients operated for symptomatic uterine broids or leimyomas between 2017 to2021. From data it was evident that maximum incidence (69%) was in the 40-50 age group. Conclusions: The age prevalence of broids or uterine leiomyomas was maximum in the age group of 40-50 and very less in below 30 and above 60 age groups. These ndings were also documented in other studies.

Clinical and Patient Reported Outcomes of Pre- and Postsurgical Treatment of Symptomatic Uterine Leiomyomas: A 12-Month Follow-up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation and Myomectomy

The objective of this study was to determine the efficacy, safety, and healthcare resource use of laparoscopic radiofrequency ablation (LAP-RFA) compared with myomectomy in patients with symptomatic uterine leiomyomas (ULs). This was a secondary analysis of the original postmarket randomized, multicenter, longitudinal, comparative TRUST (Treatment Results of Uterine Sparing Technologies) United States trial in patients with symptomatic ULs. After the procedure, subjects were followed over a 12-month period. Multicenter trial, including hospitals with or without an academic affiliation, surgery centers, and fertility centers performing outpatient procedures for uterine myomas. A total of 57 patients were randomized to either LAP-RFA (n=30) or myomectomy (n=27). LAP-RFA or myomectomy (laparoscopic or abdominal). The main outcome measures of this study were part of the secondary outcomes of the original TRUST trial. The primary outcome of this study was the reduction of UL symptoms and the improvement in patient-reported outcomes scores over time. Secondary outcomes included postprocedure hospitalization, length of stay, complications, reinterventions, and recovery time. There was a significant improvement in UL symptoms at 3 and 12 months after the procedure within each treatment group, and these improvements were similar between treatment groups. There was a significant reduction in UL symptoms per month between baseline and 12-months after the procedure for both LAP-RFA and myomectomy of 72% and 85%, respectively. A significant improvement was seen in all patient-reported outcomes scores over time for both groups. At 3 and 12 months after the procedure, the percentages of patients who were hospitalized in the LAP-RFA group were 74% and 49% lower than those of patients in the laparoscopic myomectomy group, respectively, with the 3-month difference being statistically significant. The length of hospital stay was significantly shorter in the LAP-RFA group compared with the myomectomy group (8.0 ± 5.7 hours vs 18.8 ± 14.6 hours; p < .05). Doctors recommended taking significantly less time off before returning to work for the patients in the LAP-RFA group compared with those in the myomectomy group (10.3 ± 5.1 days vs 14.5 ± 5.4 days; p < .05). The total number of days until back to normal activity was significantly lower in the LAP-RFA group compared with the myomectomy group (16.3 ± 15.2 days vs 26.5 ± 15.9 days; p < .05). The results from this 12-month follow-up study suggest that LAP-RFA is a safe, effective, uterine-sparing alternative to laparoscopic myomectomy in the treatment of ULs. These data points build on previously published studies showing that LAP-RFA has lower healthcare resource use overall, including lower postprocedure hospitalization rate and shorter length of stay. In clinical practice, LAP-RFA is a promising treatment approach to ULs for women.

Two-Port Robotic Laparoscopic Hysterectomy

<h3>Study Objective</h3> To demonstrate a surgical video wherein a technique for port-reducing robot-assisted laparoscopic hysterectomy was performed with the use of a gel-capped multi-trocar port that accommodates necessary instruments to safely complete the procedure. <h3>Design</h3> Case report, step-by-step video describing a port-reducing robot-assisted laparoscopic hysterectomy with the gel-capped multi-trocar port. Institutional Review Board (IRB) approval was not required. <h3>Setting</h3> Tertiary referral medical center in New Haven, Connecticut. A 40-year-old female with symptomatic uterine leiomyoma who underwent failed medical management. She has completed her childbearing. Her body mass index was 41 kg/m². A pelvic sonogram showed a 10-centimeter uterus with a 10-centimeter fibroid. On examination, her uterus was mobile. <h3>Patients or Participants</h3> Singular patient who consented for this demonstration video. <h3>Interventions</h3> The patient underwent an uncomplicated robotically assisted total laparoscopic hysterectomy and bilateral salpingectomy. This was accomplished using a two-port technique. A multi-channel port system and a second robotic trocar were used. <h3>Measurements and Main Results</h3> Effective dissection of the adnexal structures and ligaments of the uterus was accomplished. Isolation, coagulation, and transection of blood vessels was optimally done with the vessel sealer. Despite the size of the uterus and leiomyoma, the specimen was completely removed transvaginally, without morcellation. Vaginal cuff closure was done with delayed absorbable barbed suture with ease. The three-centimeter fascial incision was re-approximated. There were no intra-operative complications. Estimated blood loss was 150 ml. She was discharged home on the same day. Her final histopathology was benign. <h3>Conclusion</h3> The two-port robotic hysterectomy with the gel-capped multi-channel laparoscopic port afforded the use of additional necessary laparoscopic instruments to safely complete the procedure while avoiding the usual three to five port incisions most gynecological surgeons use. This approach utilized the advantages of robotic laparoscopy: superior operative visualization, improved instrument mechanics and stabilization, and upgraded ergonomics for the surgeon. Our robotic hysterectomy technique is a feasible alternative for the appropriately selected patients.

UTERINE ARTERY EMBOLIZATION AS AN EFFICACIOUS STAND-ALONE TECHNIQUE IN MANAGEMENT OF SYMPTOMATIC UTERINE LEIOMYOMATA

Background: Uterine artery embolization is now evolving to be the first-line therapy for symptomatic uterine leiomyoma alongside elder conventional alternatives comprising hysterectomy and myomectomy whether surgical or endoscopic. Many clinical trials have confronted UAE and surgical therapies as regard safety and efficacy in treatment of symptomatic leiomyomas where UAE exhibited comparable short and mid-term clinical outcomes, encompassing symptomatic amelioration, better quality of life and psychological satisfaction benefiting from uterine preservation.Aim of the Work: to emphasize the role of the trans-catheter uterine artery embolization as an effective stand-alone technique in treating the symptoms attributable to uterine leiomyomata.Patients and Methods: This study included 30 patients with uterine fibroids referred from gynecology clinic to interventional radiology unit to be counseled for UAE.Results: Follow-up symptomatic assessment was done for all patients at 1 and 3 months. Most patients confirmed symptomatic amelioration at 1 months persisting or continue at 3-month follow-up visit. Among 21 patients presented with bleeding, 90.5% of patients reported symptomatic improvement at 1 month post-procedurally continued to increase to reach 95.2% at 3 months follow-up visit, however, no significant symptomatic change was noted between 3, 6 months follow up. Fourteen patients complained from pressure symptoms. At 1-month follow-up, 71.44% of patients stated improvement, 14.29% had stationary course with similar percentage exhibited slightly worse response. Contrariwise, 85.71% of patients reported symptomatic amelioration at 3 month and 14.3% had no change. Indifferent from bleeding, a highly statistically significant time improvement between 1, 3 months follow up is notable. Of 13 patients admitted with pelvic pain, 53.9% get improved, 30.77% showed no change, 15.38 % gave slightly worse response in comparison to 84.7%, 7.69%, 7.69% at 1, 3 months follow-up clinical assessment visits. There is clinical reduction of pain between 1, 3 months however it didn’t reach clinical significance. Among three patients presented with infertility, one gets pregnant at 3 months follow up with no significant change between 1, 3 months follow up. On MRI, the mean uterine volume was reduced by 30% 6 months after treatment. Similarly, mean dominant leiomyoma volume was reduced by 44 % after 6 months. There was highly statistically reduction of volume between 1 and 6 months follow up. Conclusion: Although limited by small sample size however we might conclude that UAE is associated with considerable cumulative reduction of leiomyoma volume that parallels patients’ symptomatic amelioration and psychological satisfaction and should be considered among first lines of management of symptomatic leiomyoma particularly in child-bearing age.

PMD2 Laparoscopic Radiofrequency Ablation VS Laparoscopic Myomectomy in the Treatment of Symptomatic Uterine Leiomyomas: A Meta-Analysis of Randomized Controlled Trials

This meta-analysis reviews the evidence from randomized controlled trials (RCTs) which compare laparoscopic radiofrequency ablation (LAP-RFA) and laparoscopic myomectomy (LM), two uterine sparing procedures for managing symptomatic uterine leiomyomas (UL).