Myoma Type Research Articles

Effectiveness of Cabergoline in Comparison with Control in Women with Fibroids Uterus: A Randomized Clinical trial

Background: Uterine fibroids are one of the most common benign tumors that cause abnormal bleeding and pain in women of reproductive age. One of the objectives of this study is to evaluate the effect of cabergoline drug on the size and volume of uterine bleeding as well as menopausal symptoms in women with uterine myomas. Methods: This double-blind clinical trial was conducted among 80 women with fibroid myomas and Abnormal Uterine Bleeding (AUB). The participants were allocated to two groups after random allocation. Group I received Cabergoline, 1 tablet (0.5 mg/w) orally once a week for 3 months. Group II obtained a placebo tablet (0.5 mg/w), taken at the same time. Results: 80 patients were included in the study (40 patients in the control group and 40 patients in the cabergoline treatment group). No statistically significant difference was observed between the two groups in terms of age, number of pregnancies, number of births, body mass index, uterine myoma characteristics, myoma type, myoma volume, and myoma number. A 37% decrease in myoma size was observed in the cabergoline recipients, as well as a 25% decrease in the placebo group, which is not statistically significant (p-value >0.05). Conclusion: Cabergoline drug reduces the volume of bleeding and the number of uterine myomas, but this reduction is not statistically significant and requires more studies in this field.

Monogram and Heat Map on Magnetic Resonance Imaging to Evaluate the Recommendation for Myomectomy in Patients with Infertility: A Pilot Study.

Uterine myomas can cause infertility. Studies are attempting to determine the indications for myomectomy. However, the multiplicity and localization of myomas complicate this issue. We aimed to develop a visualization tool to aid patients with infertility in their decision-making for myomectomy. We included 191 women with uterine myoma attending an outpatient infertility clinic, of whom 124 patients underwent myomectomy. Of these, 65 (52.4%) patients became pregnant within 17.6 months after surgery, and 54 (83.1%) of them had a live birth. A logistic regression model predicting the pregnancy rate (area under the curve, 0.82; 95% confidence interval, 0.74-0.89; validation value, 74.6%) was generated using the leave-one-out cross-validation method. This model incorporated five factors: age, maximum level of infertility intervention following myomectomy, presence of submucosal myoma, maximum diameter of the myoma, and type of myomas (multiple or single). We successfully visualized the degree of involvement of each factor in the pregnancy rate by developing a nomogram based on this model. We expanded the data from the preoperative magnetic resonance images and applied machine learning using a convolutional neural network. The classification accuracy was 71.4% for sensitivity and 77.7% for specificity. Heatmap images, generated using gradient-weighted class activation mapping to show the classification results of this model, could distinguish between myomas that required enucleation and those that did not. Although a larger sample size is needed to further validate our findings, this innovative pilot study demonstrates the potential of machine learning to refine assessment criteria and improve patient decision-making.

Large-scale uterine myoma MRI dataset covering all FIGO types with pixel-level annotations

Uterine myomas are the most common pelvic tumors in women, which can lead to abnormal uterine bleeding, abdominal pain, pelvic compression symptoms, infertility, or adverse pregnancy. In this article, we provide a dataset named uterine myoma MRI dataset (UMD), which can be used for clinical research on uterine myoma imaging. The UMD is the largest publicly available uterine MRI dataset to date including 300 cases of uterine myoma T2-weighted imaging (T2WI) sagittal patient images and their corresponding annotation files. The UMD covers 9 types of uterine myomas classified by the International Federation of Obstetrics and Gynecology (FIGO), which were annotated and reviewed by 11 experienced doctors to ensure the authority of the annotated data. The UMD is helpful for uterine myomas classification and uterine 3D reconstruction tasks, which has important implications for clinical research on uterine myomas.

Benefits and safety of myomectomy during cesarean section

Uterine myoma is a tumor in the uterus that is generally benign. There are many types of uterine myomas. These tumors can grow on the outer wall of the uterus, on the uterine muscle, or it can also be on the inner wall of the uterus. The most frequent kind of uterine tumor is myoma. Uterine myoma mostly occurs in women over thirty years of age. Its prevalence ranges from 5.4% to 77%, with uterine fibroids accounting for up to 5% of pregnancies. The myomectomy procedure is an option for women who still want children but are concerned about the possibility of subsequent surgical intervention. The myomectomy cesarean section is indicated if there were complications related to the myoma in a previous pregnancy. It also avoids the possibility of repeat laparotomy for fibroid removal in the future. Myomectomy surgery should be planned based on fibroids' location, size, and quantity, using suitable imaging. Myomectomy cesarean section can be an option compared to cesarean section without myomectomy, especially if it is performed by experienced surgeons with proper hemostatic techniques and performed in tertiary-level health facilities. This study will discuss the details of the benefits and safety of myomectomy during cesarean section so that it might be considered before performing this procedure.

Evaluation of the anatomical locations and sizes of uterine fibroids from ultrasound examination in Ghana.

Uterine fibroids locations and sizes, have significant influences on the quality of life of women especially pregnant women and on live birth rate. To determine the anatomical locations and sizes of uterine fibroids and assess any possible associations with age groups. This retrospective study reviewed the locations and sizes of a total of 3,542 patients who were ultrasonographically diagnosed with uterine fibroids from January 2019 to December 2021. The obtained data were analysed using GNU PSPP, and Python on Jupyter Notebook with statistical significance level set at p≤0.05. The overall average diameter of uterine myoma was 5.50±2.60cm (95%CI=5.41-5.58, range=1.00cm-19.10cm) and the respective mean diameter of intramural, subserosal and submucosal fibroids were 5.53±2.60cm (95%CI=5.44-5.62), 5.50±2.27cm (95%CI=5.27-5.74) and 5.82±2.77cm (95%CI=5.49-6.14). Most of the fibroid nodules were small (48.36%, n=1713) and only 5.84% (n=207) were large (>10cm). Posterofundal fibroids and lower anterior myomas were mostly seen in the 35-44 years age class. The majority of the uterine fibroids were intramural and were mostly at the anterior uterine wall. The submucosal fibroids, even though the rarest, were averagely larger than the other types of uterine myomas. The diameter of uterine fibroids increased with age.

The challenge of FIGO type 3 leiomyomas and infertility: Exploring therapeutic alternatives amidst limited scientific certainties.

Uterine leiomyomas (ULs) are non-cancerous tumors composed of smooth muscle cells that develop within the myometrium and represent the most prevalent pathological condition affecting the female genital tract. Despite the volume of available research, many aspects of ULs remain unresolved, making it a "paradoxical disease" where the increase in available scientific literature has not been matched by an increase in solid evidence for clinical management. Fertility stands at the top of the list of clinical issues where the role of ULs is still unclear. The leiomyoma subclassification system, released by the International Federaion of Gynecology and Obstetrics (FIGO) in 2008, introduced a new and more effective way of categorizing uterine fibroids. The aim was to go beyond the traditional classification "subserosal, intramural and submucosal", facilitating a detailed examination of individual ULs impact on the female reproductive system. The "type 3 UL" is a special type of myoma, characterized by its complete myometrial development while encroaching the endometrium. It is a unique "hybrid" between a submucous and an intramural UL, that may exert a detrimental "double hit" mechanism, which is of particular interest in patients wishing pregnancy. To date, no robust evidence is available regarding the management of type 3 ULs. The aim of this narrative review is to provide a comprehensive overview of the physiopathological mechanisms that type 3 UL may exert on fertility, and to present new perspectives that may help us to better understand both the need for and the methods of treating this unique type of fibroid.

Incidence of Intrauterine Adhesions After Hysteroscopic Myomectomy in Patients Seeking Fertility

To study the incidence of intrauterine adhesions (IUAs) after hysteroscopic myomectomy. Previous studies report a range of incidence for IUAs after hysteroscopic myomectomy. A retrospective review study. An academic community hospital in the Boston metropolitan area. Patients undergoing hysteroscopic myomectomy at our institution from January 2019 to February 2022. Patients were excluded if they did not have plans for future fertility or had a new diagnosis of cancer. All patients underwent hysteroscopic myomectomy using bipolar resectoscope without postoperative medical or barrier treatment. All procedures were performed by 1 of 4 fellowship-trained high-volume gynecologic surgeons with resident and fellow assistance. Incidence of postoperative IUAs was assessed and treated using second-look office hysteroscopy. A total of 44 patients without preoperative IUAs underwent hysteroscopic myomectomy during our study period, and 4 patients (9.1%) developed new IUAs. Among 9 patients who were found to have preoperative IUAs and underwent concurrent hysteroscopic myomectomy and lysis of adhesions, we found a recurrence of IUAs in 5 patients (55.6%). We found the number, size, and deepest type of myoma removed were not correlated to an increased risk of new IUA formation. In addition, removing myomas on opposing walls during the same operation did not increase the incidence of new IUAs. Formation of IUAs after hysteroscopic myomectomy is a well-documented consequence. Our reported incidence of 9.1% of new IUAs that are not affected by the number, size, deepest type of myoma resected, and resection of myomas on opposing uterine walls contributes to the current literature. In addition, our finding of 55.6% of recurrent IUAs in patients undergoing both hysteroscopic myomectomy and lysis of adhesions highlights a high-risk population requiring additional study.

Pregnancy outcomes following ultrasound-guided high-intensity focused ultrasound in submucous leiomyomas: a retrospective study

Objective To investigate the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) on pregnancy in submucous leiomyomas. Materials and methods Between October 2015 and October 2021, a retrospective observational study was conducted at the Affiliated Hospital of North Sichuan Medical College, China, for 32 women with submucous leiomyomas who became pregnant after USgHIFU. Pregnancy outcomes, submucous leiomyomas characteristics, and USgHIFU parameters were analyzed. Results A total of 17 (53.1%) deliveries were successfully achieved, with full-term delivery in 16 (94.1%) patients and preterm delivery in 1 (5.9%). After USgHIFU, the effective volume in the uterus cavity and the volume of submucous leiomyomas shrank in all 32 patients. The median time to achieve pregnancy after USgHIFU was 11.0 months. Before pregnancy, myoma type was downgraded in 13 (40.6%) patients, stable in 10 (31.3%) and upgraded in 9 (28.1%). The vaginal expulsion rate of submucous leiomyomas was 28.1%, with complete expulsion in 3 (9.4%) patients and partial expulsion in 6 (18.8%). After USgHIFU, the size of submucous leiomyomas did not increase in each trimester (all p > 0.05). The high complications rate during pregnancy (7/17, 41.2%) was associated with advanced maternal age, with only one (5.9%) premature rupture of membranes possibly associated with submucous leiomyomas. There were 6 (35.5%) vaginal delivery and 11 (64.7%) cesarean sections. All 17 newborns developed well, with a mean birth weight of 3482 g. Conclusions In patients with submucous leiomyomas, pregnancies and full-term deliveries can be successfully achieved following USgHIFU, with few related complications.

Risk factors based on myoma characteristics for predicting postoperative complications following cesarean myomectomy.

To evaluate the influence of myoma characteristics on cesarean myomectomy and to demonstrate its additional advantages. Retrospective data were collected from 292 women with myomas who had undergone cesarean section at Kangnam Sacred Heart Hospital between 2007 and 2019. We performed subgroup analysis according to the type, weight, number, and size of myomas. Preoperative and postoperative hemoglobin levels, operative time, estimated blood loss, length of hospital stay, incidence of transfusion, uterine artery embolization, ligation, hysterectomy, and postoperative complications were compared among subgroups. There were 119 patients who had cesarean myomectomy and 173 who had cesarean section only. An increase in postoperative hospitalization and operation time was observed in the cesarean myomectomy group compared to that in the caesarean section only group (mean difference, 0.7 days, p = 0.01, 13.5 minutes, p <0.001). Estimated blood loss, hemoglobin differences, and transfusion rates were higher in the cesarean myomectomy than in the cesarean section only group. There were no differences in postoperative complications (fever, bladder injury, and ileus) between the two groups. No hysterectomy cases were reported in the cesarean myomectomy group. In subgroup analysis, the larger and heavier the myoma, the higher the risk of bleeding that led to transfusion. Estimated blood loss, differences in hemoglobin, and transfusion rate increased depending on myoma size and weight. A significant increase in postoperative hospitalization was observed in women with larger and heavier myomas. However, there was no statistical difference among the three types of myomas. In cesarean myomectomy, larger (≥ 10 cm), and heavier myomas (≥ 500 g), were associated with postoperative outcomes, but not the number or type of myoma. The safety of cesarean myomectomy is not inferior to that of caesarean section only, considering its positive effects such as gynecological symptom relief and avoidance of the next surgery.

Hysteroscopic myomectomy with the IBS® Intrauterine Bigatti Shaver: A Retrospective Comparative Analysis of the impact of rotational speed and aspiration flow rate

Myoma removal remains a challenge hysteroscopically including for the "IBS®" Intrauterine Bigatti Shaver technique. To evaluate whether the Intrauterine IBS® instrument settings and the myoma size and type are prognostic factors for the complete removal of submucous myomas using this technology. This study was conducted at the San Giuseppe University Teaching Hospital Milan, Italy; Ospedale Centrale di Bolzano - Azienda Ospedaliera del Sud Tirolo Bolzano, Italy (Group A) and the Sino European Life Expert Centre-Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China (Group B). In Group A: surgeries were performed between June 2009 and January 2018 on 107 women using an IBS device set to a rotational speed of 2,500 rpm and an aspiration flow rate of 250ml/min. In Group B: surgeries were performed between July 2019 and March 2021 on 84 women with the instrument setting to a rotational speed of 1,500 rpm and aspiration flow rate of 500 ml/min. Further subgroup analysis was performed based on fibroid size:<3 cm and 3-5 cm. Both Groups A and B were similar in terms of patient age, parity, symptoms, myoma type and size. Submucous myomas were classified according to the European Society for Gynaecological Endoscopy classification. All patients underwent a myomectomy with the IBS® under general anaesthesia. The conventional 22 Fr. Bipolar Resectoscope was used in cases requiring conversion to the resection technique. All surgeries were planned, performed and followed by the same surgeon in both institutions. Complete resection rates, total operation time, resection time and used fluid volume. Complete resection with the IBS® Shaver was seen in 93/107 (86.91%) in Group A versus 83/84 (98.8 %) in Group B (P=0.0021). Five patients (5.8%) in Subgroup A1 (<3 cm) and nine patients (42.9%) in Subgroup A2 (3cm~5cm) could not be finished with the IBS (P<0.001, RR=2.439), while in Group B only one case (8.3%) in Subgroup B2 (3cm~5cm) underwent a conversion to bipolar resectoscope (Group A: 14/107=13.08% vs. Group B: 1/84=1.19%, P=0.0024). For <3cm myomas (subgroup A1 versus B1) there was a statistically significant difference in terms of resection time (7.75±6.363 vs. 17.28±12.19, P<0.001), operation time (17.81 ± 8.18 vs. 28.19 ±17.614, P<0.001) and total amount of fluid used (3365.63 ± 2212.319 ml vs. 5800.00 ± 8422.878 ml, P<0.05) in favour of Subgroup B1. For larger myomas, a statistical difference was only observed for the total operative time (51.00±14.298 min vs. 30.50±12.122 min, P=0.003). For hysteroscopic myomectomy using the IBS®, 1,500rpm rotational speed and 500ml/min aspiration flow rate are recommended as these settings result in more complete resections compared to the conventional settings. In addition, these settings are associated with a reduction in total operating time. Reducing the rotational speed rate from 2500 rpm to 1500 rpm and increasing the aspiration flow rate from 250 ml/min to 500 ml/min improve complete resection rates and reduce operating times.

Characteristics of Submucous Myomas and the Risk of Anemia.

Background and Objectives: Uterine fibroids still represent the most common indication for hysterectomy for benign pathologies. In the United States, more than 479,000 hysterectomies are performed annually, 46.6% for myomas and 47.7% in women aged from 18 to 44 years. By applying appropriateness criteria to this procedure, it has been estimated that overuse ranges from 16 to 70%. One of the main reasons that induce patients and gynecologists to consider hysterectomy is represented by severe anemia. Materials and Methods: This is a retrospective cohort study of 202 patients with uterine fibroids diagnosed by transvaginal ultrasound who underwent a hysteroscopic procedure. Myoma grade, size, location, and number were assessed by transvaginal scan and office hysteroscopy and correlated to the pre-treatment hemoglobin level. Results: Univariate analysis showed that anemia does not have a statistically significant association with myoma number and with age considered as a numerical predictor. In the patients with myoma type 0, there is a possibility of 81% having anemia regardless of menorrhagia. On the contrary, in patients with myoma type 1 or type 2, the possibility of having anemia varies according to the presence or absence of menorrhagia. If there is menorrhagia, the risk of moderate anemia is only present for myomas &gt;60 mm. Conclusions: The results of this study may contribute to defining objective criteria for the management of submucous myomas and anemia. Our data suggest that submucosal myomas type 0 &gt;10 mm should always be treated, putting patients at risk for anemia. Myomas type 2 and 3 should be treated for the risk of anemia in the presence of menorrhagia episodes or if &gt; of 60 mm. Adequate management of anemia and myomas could reduce the rate of unnecessary hysterectomies.

Subacute Non-Puerperal Uterine Inversion: A Rare Complication of Uterine Myoma

Subacute non-puerperal uterine inversion is an extremely rare clinical situation that constitutes a medico-surgical emergency that can be life-threatening for women due to the risk of bleeding. We report the case of a 45 years-old patient, second parous received urgently with hemorrhagic shock. The clinical examination confirmed the diagnosis of uterine inversion secondary to a fundic myoma type 0 delivered through the cervix. Resuscitation was carried out followed by surgical management by a mixed vaginal and abdominal approach to perform a hysterectomy. Through this clinical case, we recall the epidemiological aspects of this pathology as well as the diagnostic and therapeutic difficulties.

The Blooming phenomenon: a rarity, but a dilemma in hysteroscopic resection of myomas

Modern surgical technologies allow gynecologists to treat most submucosal myomas hysteroscopically by some form of resection. What appears on imaging or direct visualization to be a submucosal myoma can be a single tumor, or may represent multiple smaller myomas appearing as one, compacted together in a typical pseudo capsule. During myoma resection, the effect of the media used to induce distension can vary, depending on the morphology of the myomas. After starting resection, the pressure of the distending media can push truly solitary myomas to somewhat flatten against the uterine wall. However, in the second type of myoma, the fluid can displace the myomas into the uterine cavity, an appearance similar to the blooming of a flower. The tip of the hysteroscope may enter the dissected spaces between the myomas, which impairs the panoramic view. This phenomenon may cause inadequate treatment of the myomas encountered during hysteroscopic myomectomy. In this study, the “Blooming phenomenon” is introduced, and the problems created by this phenomenon and solutions for its management are considered.

Efficacy, Complications, and Factors Predictive of Response to Treatment with Transvaginal Radiofrequency Ablation for Symptomatic Uterine Myomas

Transvaginal radiofrequency ablation is a minimally invasive treatment for myomas in women who wish to preserve their uterus. This study aimed to evaluate the efficacy and safety of transvaginal radiofrequency to treat myomas and to identify factors predictive of the response to treatment. Prospective case series. Virgen de las Nieves University Hospital, a tertiary center in Granada, Spain. The participants were 59 patients with myomas. Transvaginal radiofrequency ablation. The variables recorded were personal (age and type of myoma), procedure dependent (pain, need for analgesia, duration of sick leave, procedure duration, and complications), clinical (total days of menstrual bleeding and days of heavy menstrual bleeding), and score on the symptom severity scale of the Uterine Fibroid Symptom and Quality of Life Questionnaire. Myoma volume was determined by ultrasonography. Changes in clinical variables and myoma volume were analyzed 2, 6, and 12 months after the procedure. Moreover, the influence of age, initial myoma size, type of myoma, and duration of the procedure on the outcomes of treatment were analyzed. Statistically significant improvements in symptoms were seen in all variables analyzed for bleeding at 0, 2, 6, and 12 months, and a significant improvement was seen in the symptom severity scale score 12 months after the procedure. Mean myoma volume (in milliliters) was significantly lower 2, 6, and 12 months after treatment (p <.05). At 12 months, the mean reduction in myoma volume was more than 80%. Patient age and initial myoma size were identified as factors predictive of the outcomes. Transvaginal radiofrequency ablation was an effective and safe technique for the treatment of myomas. The patient's age and initial size of the myoma influenced the outcome of treatment.

Clinicopathological features and prognostic factors for uterine myoma.

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

LAPROSCOPIC MYOMECTOMY VERSUS OPEN MYOMECTOMY FOR UTERINE FIBROIDS

Fibroids are common benign tumours arising in the uterus.Myomectomy is the surgical treatment of choice forwomenwith symptomatic fibroids who prefer or want uterine conservation. Myomectomy can be performed by laparoscopy or open myomectomy. Aim of study is to determine the benefits and harms of laparoscopic myomectomy compared with open myomectomy.It is a comparative study conductedover 1 year in Department of Obstetrics and Gynecology, GMC ,Akola,Maharashtra . 50 patients were included in study who were having uterine fibroid. Subjects were explained about surgery as treatment.30 subject undergone Laproscopic myomectomy and 20 subjects undergone open myomectomy.The clinical data of patients who underwent OM and LM was analyzed. The data recorded comprised patientdemographic information and clinical characteristics includingage, weight, type, and size of myoma and myomectomyindications; and perioperative data including estimation ofblood loss, duration of surgery, complications, and lengthof hospital stay.&#x0D; Keywords: Laproscopic myomectomy (LM), open myomectomy(OM), uterine fibroid.

Observation of pregnancy outcomes in patients with hysteroscopic resection on submucous myomas.

The aim of this study was to assess postoperative pregnancy outcomes in patients with different types of submucous myomas after hysteroscopic resection. This retrospective unicentric study used data from the electronic medical records system of the hospital. All patients (n=77) who underwent hysteroscopy for submucous myomas between November 2010 and December 2018 were included. Patients were divided into three groups according to the myoma classification (G0, G1, and G2). Medical files were reviewed and phone questionnaires were conducted to evaluate demographic characteristics, clinical features, surgical treatment, and pregnancy outcomes. The median age of the patients was 32 (30.0, 34.0) years. The myoma diameter was 2.9 (2.0, 3.8) cm. The operation duration was 50.0 (30.0, 75.0) min. There were 15 patients in Group G0, 20 patients in Group G1, and 37 patients in Group G2. Follow-up data were available for 65 of the 77 patients. The total pregnancy rate was 58 (89.2%) of 65. The live birth rate was 41 (70.7%) of 58. There was no significant difference in pregnancy rate (G0 100% vs. G1 76.5% vs. G2 91.2%; p=0.097) or in live birth rates among the three groups (G0 78.6% vs. G1 53.8% vs. G2 74.2%; p=0.325). There was no difference in pregnancy outcome among the three types of submucosal myomas. Our results support the idea that hysteroscopic myomectomy is an effective option for submucous myomas with good long-term pregnancy outcomes.

Robotic Myomectomy: Five Modifications in Our Practice.

We discuss five technical modifications made over 8 years in the technique of robotic myomectomy at our institution. Universal preoperative MRI was the first modification. Precise hysterotomy incisions were planned by accurate myoma mapping. The second modification was to reduce the number of ports. We performed surgery with one 12-mm-port for the camera and one 8-mm-port on either side of the patient for scissors and fenestrated bipolar forceps. Third modification was to reduce the number of robotic instruments by using laparoscopic myoma screw instead of robotic tenaculum during enucleation and discard the use of a second needle driver and prograsp forceps. So instead of six instruments in classical technique, we now use only three instruments thus reducing the cost of instruments by 40-50%. The fourth modification was to use a single 30 or 45cm barbed suture. A single long suture efficiently managed by wristed needle driver of robot was sufficient in most cases for hysterotomy closure. This reduces the time needed for multiple needle pass and cost due to reduced number of sutures used. The fifth modification was to not use the electro mechanical morcellator and commercially available bags. We do cold knife morcellation in indigenous plastic bags. Over a period of eight years, we have made robotic myomectomy efficient and reduced the cost of instruments by 40-50% as compared to the classical technique. This has enabled wider adoption of robotic myomectomy at our institution thus reducing open myomectomy in all types of myomas.

Comparison between Robotic Single-Port Myomectomy Using New da Vinci SP® Surgical System and Robotic Multi-Site Myomectomy

<h3>Study Objective</h3> To compare the perioperative outcomes of the robotic single-port myomectomy (RSPM) using the new da Vinci SP® surgical system with those of the robotic multi-site myomectomy (RM) using the da Vinci Xi® surgical system. <h3>Design</h3> Multicenter retrospective case-controlled study. <h3>Setting</h3> A university tertiary care hospital. <h3>Patients or Participants</h3> A total of 101 patients were enrolled. 67 patients underwent RSPM and 34 patients underwent RM at November 2018 to May 2020 were included. <h3>Interventions</h3> All patients underwent robotic myomectomy who diagnosed uterine myoma with target size that the instrument could operate by entering the umbilicus. The choice of surgical modality was not influenced by the patient's history of previous abdominal surgery, body mass index, uterus size, location or type of myoma, or myoma size. <h3>Measurements and Main Results</h3> RSPM vs. RM patients demographics had no difference significantly in mean age, BMI, maximal diameter of myoma and total number of myomas. In terms of surgical outcomes, RSPM and RM has comparable in EBL (50 mL vs. 150 mL, p <0.05), Hemoglobin change (2.2±0.8 g/dl vs. 2.6±1.1 g/dl, p=0.046), operative time (105 min vs. 110 min, p = 0.001). Post-operative complication, conversion to laparotomy rate, tranfusion rate were similar between the two groups. <h3>Conclusion</h3> Robotic single-port myomectomy using new da Vinci SP® surgical system is feasible surgical modality as like as multi-site myomectomy. Further studies are needed to confirm these preliminary results and to determine the proper indications for the surgery.

Number of Myomas Is the Most Important Risk Factors for Blood Loss of Robotic Myomectomy: Analysis of 242 Cases

Study Objective To find out factors affecting estimated blood loss (EBL) during reduced port robotic myomectomy. Design Retrospective study. Setting University-based hospital. Patients or Participants Two hundred forty-two patients who underwent reduced port robotic myomectomy (RM) between 1 January 2019 and 28 February 2021 by two gynecologic surgeons. Interventions Among 448 patients who underwent RM during the study period at our hospital, 47 patients who underwent single site RM (n=34) or single port RM (n=13) were excluded. For surgical proficiency, 242 cases of two surgeons who performed over 80 cases of RM during the study periods were included in this study. Measurements and Main Results The primary endpoint was to identify the factors affecting EBL and the secondary endpoint was to identify the factors of total OT during multi-port RM. Univariate and multivariate analysis were used to identify the factors affecting the EBL and OT during RM. Medians of the maximal diameter and weight of the removed myomas were 9.00 (IQR: 7.00-10.00) cm and 249.75 (IQR: 142.88-401.00) g, respectively. The median number of myomas was 2 (IQR: 1-4) with the range of (1–34). There were 155 cases with low EBL and 87 cases with high EBL. The most common main type of myomas was intramural type (n=179). The odds of having EBL>320ml increased by 251% (OR=2.51; 95%CI: 1.16-5.42) for 5-9 myomas and by 647% (OR=6.47; 95%CI: 1.87-22.33) for ≥10 myomas. The odds of subserosal type myomas decreased by 77% (OR=0.33; 95%CI: 0.14-0.80). History of abdominal surgery other than c-section were positively correlated with EBL. Weights of the retrieved myomas and previous c-section were not correlated with EBL. Conclusion Number of myomas (5-9 and ≥10), maximal diameter, and history of abdominal surgery other than c-section affect EBL in RM. To find out factors affecting estimated blood loss (EBL) during reduced port robotic myomectomy. Retrospective study. University-based hospital. Two hundred forty-two patients who underwent reduced port robotic myomectomy (RM) between 1 January 2019 and 28 February 2021 by two gynecologic surgeons. Among 448 patients who underwent RM during the study period at our hospital, 47 patients who underwent single site RM (n=34) or single port RM (n=13) were excluded. For surgical proficiency, 242 cases of two surgeons who performed over 80 cases of RM during the study periods were included in this study. The primary endpoint was to identify the factors affecting EBL and the secondary endpoint was to identify the factors of total OT during multi-port RM. Univariate and multivariate analysis were used to identify the factors affecting the EBL and OT during RM. Medians of the maximal diameter and weight of the removed myomas were 9.00 (IQR: 7.00-10.00) cm and 249.75 (IQR: 142.88-401.00) g, respectively. The median number of myomas was 2 (IQR: 1-4) with the range of (1–34). There were 155 cases with low EBL and 87 cases with high EBL. The most common main type of myomas was intramural type (n=179). The odds of having EBL>320ml increased by 251% (OR=2.51; 95%CI: 1.16-5.42) for 5-9 myomas and by 647% (OR=6.47; 95%CI: 1.87-22.33) for ≥10 myomas. The odds of subserosal type myomas decreased by 77% (OR=0.33; 95%CI: 0.14-0.80). History of abdominal surgery other than c-section were positively correlated with EBL. Weights of the retrieved myomas and previous c-section were not correlated with EBL. Number of myomas (5-9 and ≥10), maximal diameter, and history of abdominal surgery other than c-section affect EBL in RM.