Total Laparoscopic Myomectomy Research Articles

Comparison of Postoperative Pain after Total Laparoscopic Hysterectomy and Total Laparoscopic Myomectomy

Comparison of Postoperative Pain after Total Laparoscopic Hysterectomy and Total Laparoscopic Myomectomy

腹腔鏡補助下子宮筋腫核出術と腹腔鏡下子宮筋腫核出術の侵襲についての比較検討

Background: In regard to myomectomy carried out using a laparoscope, there has been a recent transition from laparoscopic-assisted myomectomy (LAM) via a small incision to total laparoscopic myomectomy (LM). However, there are few reports documenting that LM is actually less invasive than LAM. Here, we compared the difference in invasiveness between LAM and LM. Method: We compared the data from 111 patients undergoing LAM and 85 patients undergoing LM at our hospital, after obtaining informed consent, between January 2009 and December 2012. We limited our analysis to patients in whom the specimen weight was 600 g or lower and excluded those who underwent simultaneous multiple organ surgery, such as surgical manipulation of the ovary. Variables for comparison were: the amount of blood loss, the operative time, the white blood cell count on postoperative day 1, the CRP level on postoperative day 3, and the postoperative maximum score on the VAS scale. Results: In the absence of any significant difference in the weight of the extracted specimens, the number of resected myomas was significantly larger in the LAM group. The intraoperative blood loss and the operative time were significantly lower and shorter, respectively, in the LAM group; however, the CRP level on postoperative day 3 and the postoperative maximum score on the VAS scale were significantly lower in the LM group. No significant difference was observed in the white blood cell count on postoperative day 1. Conclusion: These results suggest that LM is less invasive than LAM in the early postoperative stage.

Learning Curve of Minimally Invasive Two-Port Laparoscopic Myomectomy

BACKGROUND AND OBJECTS: To examine the learning curve of minimally invasive 2-port total laparoscopic myomectomy (TTLM). TTLM was performed by using only umbilicus and left inguinal ports, for 30 patients at our university affiliated hospital between May 2009 and February 2010. The times required for each of the 5 surgical phases of the early and late cases performed by the same surgeon were compared by using a DVD time counter. The mean surgical time was 82.5±5.2 minutes, blood loss was 42.1±7.5mL, and weight of specimen was 65.3±13.3g. The eighth case was the first in which the surgical time fell below the overall mean surgical time. Comparison of the mean time of each phase between the 7 early and the subsequent (late) cases revealed significant differences in the times required for suturing. Although this was a feasibility study, the results suggest that this technique can be mastered after 7 cases. Learning curve, Suturing.

Alexis Wound Retractor Laparoscopic Ultraminilaparotomy Myomectomy V.S Total Laparoscopic Myomectomy (Surgical Procedure Comparison)

Total laparoscopic myomectomy has gained popularity due to less wound pain, less hospital stay, less adhesion, however, the surgical procedure is time-consuming and technique challenging. It needs a long learning curve to be an expertise and a proficient surgical assistant to be present in every procedure. We used an Alexis wound Retractor to perform laparoscopic ultraminilaparotomy myomectomy .We transform the suture procedure and removal of myoma into laparotomy type which is more familiar to most surgeons.

A Novel Modification of Traditional 2-Port Laparoscopic Surgery Using a 5-mm Flexible Scope

In embryonic natural orifice transumbilical endoscopic surgery, more than 1 port is inserted through the umbilicus. In the present study, embryonic natural orifice transumbilical endoscopic surgery combined with a flexible scope was used to further improve gynecologic surgery. A surgical incision was made in the umbilical region to enter the abdominal cavity using the closed approach. A 12-mm port was placed at the umbilical incision, and the 5-mm flexible scope was inserted through the port. Another surgical port was then made in the left inguinal region for insertion of a 5-mm port while monitoring it with the flexible scope. The flexible scope was then inserted through the 5-mm inguinal port, and another 5-mm port was inserted caudal to the 12-mm port while monitoring the umbilical region with the flexible scope. The 12- and 5-mm ports were inserted through the same umbilical incision so that they were positioned vertically. The surgeon stood on the left side of the patient to manipulate the 12-mm umbilical port with the right hand and the 5-mm inguinal port with the left hand. An assistant surgeon inserted the flexible scope through the 5-mm umbilical port and manipulated it with the left hand to secure the view during surgery by appropriately adjusting the angle of the flexible scope. With the present technique, the flexible scope did not interfere with the forceps inside or outside of the body cavity because its angle could be freely set. Since March 2, 2009, we have performed 8 procedures using this surgical technique including 1 salpingectomy, 3 ovarian cystectomies, 2 total laparoscopic hysterectomies, 1 linear salpingostomy, and 1 total laparoscopic myomectomy. Intracorporeal suturing was performed in all cases but one because a suture needle could be easily inserted through the 12-mm port. Furthermore, total laparoscopic myomectomy could be completed using a 12-mm power mocellator inserted through the 12-mm port. The flexible scope and forceps did not hinder each other either inside or outside of the body cavity. Use of the flexible scope enables the conventional rigid straight forceps to be used in almost the same manner as with the conventional laparoscopic technique.

Total Laparoscopic Myomectomy: Application for Uterine Submucosal Myoma

Background: Submucosal myoma has been treated with hysteroscopic transcervical resection (TCR) . However, in cases of unstalked submucosal myoma over 3cm in diameter, TCR could lead to not only extended operation time but also extensive thermal damage on endometrium by electrocoagulation. In this study, we validated the feasibility and utility of total Laparoscopic approach for submucosal myoma treatment.Materials and Methods: Total laparoscopic myomectomy (TLM) was performed on 12 women with submucosal myoma. Our TLM procedure was as follows: a balloon catheter was detained in the uterine cavity to evaluate the degree of submucosal projection by sonohysterography. Culdotomy was performed to set acrylic vaginal pipe into intraperitoneal cavity as a larger access port. After intramyometrial injection of vasopressin, a transverse incision was made to extract myomas. As myomectomy progressed, endometrium filled with indigocarmine through a detained balloon catheter appeared transparent-blue bulge, which helped easy recognition of endometrial injury. Uterine wall was sutured layer by layer without tucking the endometrium into myometrium. The enucleated nodules were removed via a vaginal pipe.Results: The median size of dominant submucosal myomas was 5cm, the median blood loss was 120ml and the median operating time was 162 minutes. There was no correlation between the degree of submucosal projection and endometrial defect. Minimal endometrial damage was observed and one of 3 infertile patients was pregnant after surgery.Conclusion: TLM was feasible in the cases of submucosal myoma as well as intramural and subserosal myomas.

Comparison of total laparoscopic myomectomy with laparoscopic-Assisted myomectomy

Comparison of total laparoscopic myomectomy with laparoscopic-Assisted myomectomy