Transvaginal Myomectomy Research Articles

Clinical experience of using the technique of uterine artery embolization in the treatment of submucous uterine fibroids in the Vidar Medical Center, Vinnytsia (2008–2022)

Myoma of the uterus is a benign neoplasm. The technique of uterine artery embolization (UAE) is used to treat uterine fibroids and is highly effective. The principle of embolization is based on the fact that all blood vessels that supply the uterus end in the endometrium.During UAE small parts are injected – emboli, which are spread along these vessels with the blood flow. In the vessels of the myoma the emboli cannot pass through the capsule of the myoma, so they block the vessels that supply it with blood. This leads to the cessation of blood supply to myomatous nodes, and subsequently there is a decrease in the size of these nodes, on average by 50–60% during the year, with a gradual decrease during the following years of life.This minimally invasive procedure is performed under local anesthesia – after femoral artery puncture, with X-ray control of angiography and intraoperative assessment of blood flow in fibroid nodes using ultrasound (US).Over 15 years of work, 1,400 UAE operations of uterine fibroids have been performed, of which more than 70 cases are UAE of submucosal myomas. Later, when the clinical picture of expulsion of these submucosal nodes appeared, transvaginal myomectomy was performed. Such a combined technique demonstrated high efficiency.The article describes clinical cases of patients who received treatment of large submucosal myoma by the UAE method followed by transvaginal myomectomy of the nascent node. In total, 5 clinical cases are described, the results of ultrasound, macropreparations, and colposcopic images are presented. A clinical case of a uterine myoma, the size of which corresponded to 21 weeks of pregnancy and a volume of 1500 cm3, is presented: after the above complex treatment method the volume of the uterus decreased according to ultrasound examination to 122 cm3. Also, a clinical case of a patient with uterine myoma, massive bleeding, whose hemoglobin level was 67 g/l is described. The patient was performed by UAE followed by transvaginal myomectomy for expulsion of the submucosal node.So, the described complex method of treatment of submucous uterine fibroids demonstrated high efficiency of clinical results.

Perioperative nursing intervention of transvaginal myomectomy.

Perioperative nursing intervention of transvaginal myomectomy.

Transvaginal Myomectomy of a Large Obstructive Fibroid Performed at 10 Weeks Gestation [A95

INTRODUCTION: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive approach for gynecologic surgery with increasing applications. We present the case of a patient at 10weeks of gestation with a desired pregnancy who developed urinary retention related to uterine fibroids leading to recurrent urinary infections and requiring indwelling catheter. Due to this, she sought termination, however this was unsuccessful due to anatomic distortion. The patient expressed her desire to continue the pregnancy if myomectomy could be performed. Magnetic resonance imaging revealed a 10.4 cm posterior lower uterine fibroid and large left fundal fibroid. The size and position of the fibroids made access via laparoscopy or laparotomy difficult. With shared decision making, we performed a diagnostic vNOTES procedure and subsequent transvaginal myomectomy. METHODS: We performed diagnostic laparoscopy and diagnostic vNOTES procedure through a posterior colpotomy to identify pelvic anatomy and obstructing fibroid. Vasopressin was injected and fibroid excised and morcellated vaginally. A second vNOTES and cystoscopy were performed to confirm hemostasis, restoration of normal anatomy and urine outflow. Informed consent was obtained to present the case. RESULTS: The patient tolerated the procedure well, was able to void spontaneously, and discharged home on post-operative day one. Final pathology confirmed leiomyoma with degenerative features. The patient carried her pregnancy to term without further urinary obstruction and delivered a healthy infant. CONCLUSION: Vaginal surgical approaches, such as vNOTES, can provide surgical access and visualization that may not be accessible by traditional laparoscopy or laparotomy. In certain patient scenarios, this may be considered for gynecologic surgery in pregnancy.

A hybrid technique for the removal of a large prolapsed pedunculated submucous leiomyoma

Uterine leiomyomas are the most common benign pelvic tumor in females. Pedunculated submucous FIGO type 0 leiomyomas may eventually protrude through the cervical canal and prolapse into the vagina taking the name of “nascent” leiomyomas. Vaginal myomectomy is the main treatment for isolated prolapsed myoma and is successful in more than 95% of cases.We propose a hybrid technique that consists of a transvaginal myomectomy followed by an operative hysteroscopy with cervical torsion to complete the removal of the leiomyoma's pedicle.Our case demonstrates an uneventful removal of a large nascent leiomyoma using a hybrid technique for complete resection of the leiomyoma limiting the risk of recurrence.

Three Ways of Approach for Uterine Cervical Myoma during Laparoscopic Hysterectomy

Study Objective To show surgical strategy during laparoscopic hysterectomy for cervical myomas. Design Step-by-step video demonstration of the surgical procedure. Setting Leiomyomas location in the uterine cervix can reduce the mobility of the uterus and also distort the anatomical position of neighboring structures, such as the uterine artery and ureter, possibly leading to massive bleeding or ureteral injury. Thus, the surgery for cervical myomas is difficult and challenging. In this presentation, I will show our surgical strategy during laparoscopic hysterectomy for cervical myomas. Patients or Participants N/A Interventions We categorize our approaches to cervical myoma into three methods based on the myoma size and the mobility of the uterus. 1. The first method is to perform standard Total laparoscopic hysterectomy(TLH) using our usual steps. However, the lateral mobilization of the ureter is occasionally necessary to dissect the area around the cervix and parametrium safely, consequently, separation of the anterior leaf of the vesicouterine ligament may be necessary. 2.The second method is to perform partial or total enucleation of the leiomyoma via laparoscopy. After reducing the volume of the uterus and obtaining uterine mobility by enucleation, hysterectomy is performed. 3. The third method is transvaginal myomectomy assisted laparoscopic hysterectomy. Due to poor Mobility of the uterus, large volume of the myoma and limited working space, we couldn't perform enucleation of the myoma via laparoscopy. Therefore, we tried to performed transvaginal myomectomy. After that, we could resect the uterus via laparoscopy. However, this technique is possible only if there is adequate surgical space in the vagina, and the cul-de-sac can be reached easily. Measurements and Main Results Laparoscopic surgery was completed safely without requiring a conversion to laparotomy. Conclusion Using these three methods step by step customizing the surgery to best address each case, safe laparoscopic surgery is possible, and open surgery can be avoided.

Hysteroscopic-Assisted Vaginal Myomectomy for a 12cm Fibroid: A Case Report

Study Objective To demonstrate the importance of resecting large intracavitary fibroids using a combination of minimally invasive techniques, particularly vaginal morcellation and hysteroscopy. Design Video case presentation. Setting A major urban teaching institution. In the operating room, the patient was placed in dorsal lithotomy. Patients or Participants 22-year-old G0 with a 12 cm intracavitary fibroid causing heavy vaginal bleeding with a starting hemoglobin of 7.3 g/dL. She was a Jehovah's Witness and would only accept a blood transfusion in the case of an absolute emergency. Interventions The patient was admitted to the hospital and underwent a gel foam uterine artery embolization preoperatively. She was also given preoperative misoprostol and tranexamic acid. She underwent a transvaginal myomectomy with hysteroscopic assistance. Measurements and Main Results Complete resection of the large intracavitary fibroid was achieved using the combined vaginal and hysteroscopic myomectomy techniques demonstrated in this video. Minimal blood loss, decreased length of stay, reduced recovery time, and decreased need for future surgery were also achieved in this case. Conclusion The preoperative blood loss reduction strategies and combined vaginal and hysteroscopic surgical approaches minimized blood loss, hospital stay, recovery time, and need for future surgery in this patient. Additionally, a blood transfusion was avoided in a patient who is Jehovah's Witness. This video demonstrates that even large intracavitary fibroids can be resected using minimally invasive techniques.

Clinical evaluation of transvaginal myomectomy surgery: a retrospective study of 138 cases

The aim of this study was to evaluate the safety, feasibility, and effectiveness of transvaginal myomectomy surgery. We conducted a retrospective study in Shengjing Hospital of China Medical University. In all, 138 patients underwent transvaginal myomectomy from March 2009 to March 2019. The perioperative clinical data, suchas position and size of myomas, operative duration, blood loss, intraoperative and postoperative complications, and hospitalizationtime were retrospectively analyzed. All transvaginal myomectomies were performed without conversion to laparotomy. The mean vaginal operatingtime was 56.0 (± 17.2) minutes. The mean operative estimated blood loss was 89.2 (± 36.8) mL. No significant intraoperativecomplications occurred. The median time of intestinal function recovery after operation was 1 day (range 1-4 days).The median time of hospital stay was 4 days (range 3-10 days); 12 (8.7%) patients experienced postoperative morbidity. Transvaginal myomectomy is a minimally invasive surgery that can be performed without leaving a scar onthe body surface. It can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indicationfor this approach.

In-Office Versus Operating-Room Procedures for Transvaginal Removal of Prolapsed Pedunculated Submucosal Myomas

Abstract Objective: Transvaginal myomectomy is the mainstay of treatment for prolapsed pedunculated submucosal myoma. This research was conducted to evaluate the outcome of transvaginal removal of ...

A case report of a large prolapsed submucous myoma with pelvic abscess

A patient with a large prolapsed submucous myoma is usually performed by vaginal myomectomy. Acute infection is a contraindication of surgery. This report describes a 25-year-old nulliparous woman who suffered from a large prolapsed submucosal myoma with pelvic abscess that was successfully removed through vaginal myomectomy, after anti-infection therapy and GnRH to cause the myoma to shrink. This study confirms the reliability, safety, and efficiency of transvaginal myomectomy in this special case.

Management Considerations for Prolapsed Submucosal Leiomyomata: A Retrospective Cohort Study

Abstract Objective: To describe (1) sensitivity/specificity of physical examination to correctly diagnose a prolapsed vaginal mass as benign, (2) success rate for transvaginal myomectomy, (3) risk of associated malignancy. Design: A retrospective cohort study. Materials and Methods: Consecutive patients evaluated at the LAC+USC Medical Center from March 2007 to June 2012 with a diagnosis, including prolapsed leiomyoma, were reviewed. Medical records were reviewed for demographic information, clinical findings, histology reports, and clinical outcomes. Results: Two hundred twenty-six cases were identified. Mean age was 44.2 (±9.1) years and 83.6% of cases were premenopausal. The most common symptom was bleeding (79.2%); 15% of the women were asymptomatic. Most were successfully treated with transvaginal myomectomy, although 14 (6.2%) required urgent hysterectomy. There were no cases of uterine infection before intervention; delay of treatment resulted in acute bleeding in 2 of 18 women. Subsequent hysterec...

The influence of different surgery strategies on ovarian function and the sexual function of the patients with uterine fibroid

Objective To analyze two kinds of hysteromyoma resection for patients with ovarian and sexual function.Methods 32 patients with uterine fibroids were based on different surgical procedure was divided into the observation group and control group,the control group total excision of the uterine surgery,observation group Yin type uterine fibroids rejecting operation,the postoperative patients with ovarian function and function change were observed. Results Gonadotropin in postoperative observation group was （6.52 ±1.13） mIU/L,luteinizing hormone （7.62 ± 2.01）mIU/L;Postoperative gonadotropin controls （8.65 ±2.67） mIU/L,luteinizing hormone （9.43 ±2.89） mIU/L, there was statistically significant difference between the two group（t=2.939,2.057,all P〈0.05）.Observation group of patients with postoperative sexual function in each dimension score：sexual desire （133.47 ±26.29） points,sexual arousal （131.03 ±22.19） points,orgasm （139.93 ±26.79）,（136.27 ±31.05）,psychological sex abnormalities （136.24 ±33.22）points,ejaculation time （141.29 ±33.71）points were higher than those of the control group（t=2.778,2.691,2.550,1.988,1.979,3.496,all P〈0.05）.Conclusion Yin uterine fibroids eliminate surgery for patients has less effects on ovarian function and sexual function,so patients with uterine fibroids should be suggested to retain the womb,in order to improve patients postoperative quality of life and the stability of the endocrine system. Key words: Uterine fibroids; Transvaginal myomectomy; Ovarian function; Sexual function

Three types of myomectomy for hysteromyoma

Objective To explore the advantage and disadvantage and the indications oftransvaginal myomectomy (TVM),laparoscopic myomectomy (LM),and transabdominal myomectomy (TAM) for hysteromyoma.Methods 99 patients with hysteromyoma who required for myomectomy were randomly divided into TVM group,LM group,and TAM group,33 for each group.Surgical duration,intraoperative blood loss,postoperative flatus time,postoperative length of hospital stay,and medical costs were compared among the three groups.Results All the procedures were successfully completed in 99 patients.Surgical duration was obviously shortened in TVM group and TAM group than in LM group (P ＜0.05).Intraoperative blood loss was the least in TVM group but was the most in TAM group (P＜0.05).Postoperative flatus time and length of hospital stay were significantly shorter in TVM group and LM group than in TAM group (P ＜0.05) ; medical costs was significantly greater in LM group than in TVM group and TAM group (P＜0.05).Conclusions Both transvaginal myomectomy and laparoscopic myomectomy are less invasive,and have rapid postoperative recovery and a lower incidence rate of pain ;transabdominal myomectomy has the advantage of excluding the number of uterine fibroids,and no limitation in size and depth.The doctor should select an ideal treatment method basing on the patients' individual clinical features. Key words: Hysteromyoma; Transabdominal myomectomy; Transvaginal myomectomy; Laparoscopic myomectomy

Pregnancy outcomes after transvaginal myomectomy by colpotomy

To examine long-term effects of transvaginal myomectomy by colpotomy on uterine ruptures, fertility and pregnancy outcome. Transvaginal myomectomy by colpotomy was performed for sixteen patients who had symptomatic uterine leiomyomas and wished to preserve their fertility. Data on possible pregnancies, infertility treatments, hysterectomies and other reoperations during a follow-up period of ten years were retrospectively collected from the hospital records. Those who had no outpatient contacts in the hospital records were interviewed by telephone. Eight (50%) of the 16 patients tried actively to conceive and they produced 14 pregnancies: six of them had two pregnancies and two had one. The median interval between the transvaginal myomectomy and the first pregnancy was 17 months (range 14-68 months). All pregnancies were uneventful and ended in full-term delivery of a healthy infant. Uncomplicated vaginal delivery was recorded in 10 (71%), vacuum extraction in one (7%) and cesarean section in three (21%) out of 14 cases. Uterine rupture or heavy postpartal bleeding was not reported. Pregnancies after transvaginal myomectomy by colpotomy were uneventful and no uterine ruptures were detected during a long-term follow-up. Pregnancy rates after the procedure appear to be similar to results after abdominal or laparoscopic myomectomy. Transvaginal myomectomy by colpotomy is a safe and feasible treatment option for selected patients wishing to preserve their ability to conceive.

Outcomes Following Fibroid Expulsion after Uterine Artery Embolization

Purpose To evaluate retrospectively the sequelae of fibroid expulsion (FE) after uterine artery embolization (UAE). Materials and Methods From a population of 759 UAE procedures performed from July 1999 to June 2009, 37 patients were found to have a uterine fibroid communicating with the endometrial cavity resulting in “bulk” FE with the passage of large fragments or an entire tumor or “sloughing” FE with shedding or “melting” of the tumor. Medical records and magnetic resonance images were evaluated for clinical information and tumor characteristics, respectively. Results The mean age of patients with FE was 43 years ± 5 (SD), with 12 nulliparous and 25 parous. Expulsion took place a mean of 14.8 weeks ± 17.7 after UAE (range, 1.6–105.9 wk). FE was asymptomatic in 5% of cases (n = 2) and symptomatic in 95% (n = 35). Among symptomatic cases, 89% (n = 31) had bulk expulsion and 11% (n = 4) had sloughing expulsion. Forty-nine percent of patients (n = 18) had tumor expulsion at home or had an office/emergency room transvaginal myomectomy (TVM), 27% (n = 10) underwent operative TVM, and 8% (n = 3) had hysteroscopic resection. Urgent and elective hysterectomies were performed in 11% (n = 4) and 5% of cases (n = 2), respectively. Nulliparous women showed a trend toward undergoing hysterectomy compared with parous women (33% vs 8%; P =.07, Fisher exact test). Conclusions Most women tolerate FE well, with approximately half needing no operative intervention, but some may need to undergo hysteroscopy, operative TVM, or even hysterectomy. Nulliparous women are potentially at greater risk to require hysterectomy.

Comparison study of offect of three ways of the hysteromyomectomy

Objective To evaluate the feasibility,clinical effect and safety of transabdominal myomectomy (TAM) ,transvaginal myomectomy(TVM) and laparoscopic myomectomy(LM). Methods To compare the effects of operation and recovery,retrospectively analysis were done on the clinical data of 52 cases of TAM 35 cases of TVM and 30 cases of LM. Results The mean operation time was significantly shorter in the TAM group[(94. 5 ±21.3)min] than that in the LM group[( 131.2 ±49. 2)min] and TVM group[( 109. 8 ±32. 5)min] (P ＜0. 05) ;The intraoperation hemorrhage volume was significantly less in the TVM group[(121.5 ± 90. 5 )ml] than that in the TAM group [( 151.6 ± 90. 8 ) ml] and the LM group [( 149.6 ± 96. 8 ) ml] ( P ＜ 0. 05 ); About the time of gas passage by anus,the TVM group[(24. 3 ±6. 7)h] occupied the shortest time was the least,there were significant differences among the three groupa( P ＜0. 05 );The mean operation time ,the highest temperature after operation, the active time after get up,hospitalization days and temperature recovery time,there was no difference between TVM group and LM group( P ＞ 0. 05). Conclusion TVM could be performed in selected patients because it shows several advantages including good safety, less trauma, less pain, quick recovery, less complications. Key words: Leiomyoma; Gynecologic surgical procedures; Laparoscopy

Intramural leiomyoma during pregnancy becoming delivered postpartally

Uterine myoma is very common finding in women of reproductive age, and their natural history during pregnancy has been reported. This case report describes a unique postpartum natural history not previously reported. A 33-year-old, multiparous woman at the 36 weeks’ of pregnancy visited to the out patient department. ltrasonic evaluation revealed an 11×10 cm sized intramural myoma in anterior and left lateral wall of uterus. Spontaneous vaginal delivery was done at the 40 weeks’ of pregnancy. Postpartal examination and sonogram was on 6th week from the delivery revealed 7cm sized intramural myoma being delivered from the cervix. Transvaginal myomectomy was perfomed and diagnosis was histologically comfirmed. Myoma in pregnancy may changes size, shape, location postpartally. Proper management shoud be done according to the changes.

Harpoon for Transvaginal Myomectomy

Study Objective: The harpoon is used to facilitate delivery of the myoma and the uterus into the vagina in case of the transvaginal myomectomy under laparoscopy control. Methods: Via the lateral laparoscopy port, the harpoon with fixed thread is driven into the intramural myoma. The colpotomy is performed. By applying tension to the thread, the harpoon is delivered into the vagina, following it – also the dominant myoma and the uterus. The myomectomy is performed, the bed is sutured layer-after-layer; the uterus is delivered back to the abdominal cavity. The colpotomy is sutured. Results: The harpoon was first used on 4/4/05. Over 3 years, 22 surgical operations were performed. The average size of the dominant myoma was 5.9 cm (range, 3 to 10 cm). In the majority of cases, the operation was performed via the posterior colpotomy, in two cases – via the anterior colpotomy. For 15 patients with sutures on the posterior wall, second-look laparoscopy was done on the 2-3 day. There were no complications, blood transfusions and conversion to laparotomy. Conclusion: The harpoon enables performance of the myomectomy by vaginal-based technique in case of inconvenient position of the dominant myoma. Study Objective: The harpoon is used to facilitate delivery of the myoma and the uterus into the vagina in case of the transvaginal myomectomy under laparoscopy control. Methods: Via the lateral laparoscopy port, the harpoon with fixed thread is driven into the intramural myoma. The colpotomy is performed. By applying tension to the thread, the harpoon is delivered into the vagina, following it – also the dominant myoma and the uterus. The myomectomy is performed, the bed is sutured layer-after-layer; the uterus is delivered back to the abdominal cavity. The colpotomy is sutured. Results: The harpoon was first used on 4/4/05. Over 3 years, 22 surgical operations were performed. The average size of the dominant myoma was 5.9 cm (range, 3 to 10 cm). In the majority of cases, the operation was performed via the posterior colpotomy, in two cases – via the anterior colpotomy. For 15 patients with sutures on the posterior wall, second-look laparoscopy was done on the 2-3 day. There were no complications, blood transfusions and conversion to laparotomy. Conclusion: The harpoon enables performance of the myomectomy by vaginal-based technique in case of inconvenient position of the dominant myoma.

Myomectomy by vaginal route

Myomectomy by vaginal route is the least invasive of all methods for myoma removal. Compared to classical, abdominal myomectomy, it has numerous advantages, especially in cases of fundal and posterior wall myomas, but still it is relatively rarely performed. This study provides an analysis of operative and postoperative course of patients subjected to myomectomy by vaginal route in the period from 01/01/2003 to 01/11/2005 as well as the corresponding control group of patients which had undergone classical, abdominal myomectomy. The study points out to significance and advantages of application of surgical technique for removal of myoma through the posterior wall of the vagina as opposed to classical, abdominal myomectomy. Transvaginal myomectomy eliminates trauma of laparotomy, intraoperative blood loss is reduced, postoperative complications are down to minimum, postoperative recovery is shorter, and so is the number of days spent in hospital. Thus, by performing this type of surgery, a positive cost-benefit effect is obtained not only for the patient but for health authorities as well.

Transvaginal myomectomy with screw traction by colpotomy

The aim of this study is to evaluate the clinical effectiveness and safety of the enucleation of uterine leiomyomas by traction method via colpotomy. Ten women with menorrhagia, pelvic pain, or secondary infertility associated with single uterine myomas underwent transvaginal myomectomy with screw traction by colpotomy. The feasibility of the procedure, operative complications, postoperative recovery, pregnancies, and relief of symptoms were the main outcome measures. Traction myomectomy was completed vaginally in all patients. The mean operating time was 71 min and average blood loss 385 ml. The mean size of a single myoma was 6.7 cm (range 5.6-8.0 cm) and weight 153 g. One patient developed a transient hematoma. All women reported relief of their symptoms after a mean follow-up of 24 months. Three patients had a term delivery postoperatively. Traction myomectomy by colpotomy is a feasible approach for selected patients wishing to preserve their ability to conceive. A single well-lined myoma of 5-8 cm diameter and possible to reach via colpotomy is a suitable subject for the procedure, which proved a viable surgical approach.