Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss

Takeda, Satoru; Ota, Tsuyoshi; Kuroda, Hiroshi; Terao, Yasuhisa; Kuwatsuru, Ryohei

doi:10.1055/s-0039-1693041

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…MRI, an examination with very high sensitivity and specificity in the diagnosis of leiomyomas, was rarely performed in our study. It is the examination of choice in case of coexistence of a fibroid and another pelvic lesion or in case of polymyomatous uterus allowing precise analysis of the different fibroids (location, number, dimensions) [15], and also in distinguishing a fibroid suspected of sarcomatous transformation [16].…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Uterine Fibroids: About 175 Cases

Malick¹,

Edouard²,

Fatou³

et al. 2023

OJOG

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Background: Uterine fibroids are a common condition in Senegal and often symptomatic. Our study aims to determine the epidemiological profile, to clarify the diagnostic aspects and to evaluate the surgical management of patients with uterine fibroids. Patients and Method: We carried out a retrospective and descriptive study carried out over a period of 30 months, from August 1, 2017 to January 31, 2020, concerning all patients who underwent surgery for the treatment of uterine myomatosis in the department of Gynecology Obstetrics of the Hospital Principal of Dakar. The data was collected from the patients' medical records and analyzed using Excel version 2016 and R version 4 software. Results: We collected 175 surgical interventions for uterine fibroids, representing 44.7% of gynecological interventions. Most of the patients were between 30 and 39 years old, with an average age of 39 years. The nulliparous were the majority with 64.6%. The clinical symptomatology was represented by genital bleeding (32.6%), pelvic pain (18.85%) and infertility (12.6%). The diagnosis was confirmed by pelvic ultrasound in all patients with variable myoma topography. A myomectomy was performed in 82.3% of cases and a total hysterectomy in 17.7%. The postoperative course was simple in 94.2% of cases, and the results of treatment revealed a disappearance of symptoms in 94.3% of cases. Conclusion: Surgery occupies a prominent place in the management of uterine fibroids.

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Section: Discussionmentioning

confidence: 99%

Surgical Management of Uterine Fibroids: About 175 Cases

Malick¹,

Edouard²,

Fatou³

et al. 2023

OJOG

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“…13 In Takeda S study, a preoperative balloon catheter in the internal iliac artery was evaluated to reduce intraoperative bleeding in abdominal surgery. 17 Another drug that could effectively control bleeding during abdominal myomectomy was carbetocin, which is a long‐acting analog of oxytocin. In fact, the potential risk of heavy bleeding during surgery and preventing strategies remains a major concern for both anesthesiologists and surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…It has also been reported that 20% of these cases require transfusion and in 2% of them, the surgical schedule is changed to hysterectomy 13 . In Takeda S study, a preoperative balloon catheter in the internal iliac artery was evaluated to reduce intraoperative bleeding in abdominal surgery 17 . Another drug that could effectively control bleeding during abdominal myomectomy was carbetocin, which is a long‐acting analog of oxytocin.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double‐blind clinical trial

Mansour‐Ghanaei

Hosseinzadeh

Sharami

et al. 2022

Health Science Reports

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Background Uterine fibroid is a common benign pelvic tumor and abdominal myomectomy may cause excessive intraoperative bleeding, which may lead to adverse outcomes. Objective This study was planned to evaluate the effectiveness of the injection of lidocaine plus epinephrine to reduce intraoperative bleeding in abdominal myomectomy. Methods During October 2019 and May 2020, 60 eligible women with uterine fibroids were enrolled in a randomized controlled trial. Our patients were divided into two groups of lidocaine plus epinephrine defined as Group L and placebo defined as Group P. In group L, lidocaine 3 mg/kg plus 0.5 ml of adrenaline which reached to 50 cc with saline solution and in group P, 50 ml of normal saline was used. Both the combined solution and normal saline were infiltrated to the serous and myometrium above and around the fibroid before incision. Patients' demographic data, total operative time, hemoglobin changes, and the degree of surgical difficulty were evaluated and compared between the two groups. Results There was no significant difference between the two groups in terms of demographic data. Hemoglobin changes ( p 0.0001) and the degree of surgery difficulty ( p = 0.01) were significantly lower in Group L compared with Group P. In each group the drop in hemoglobin levels from baseline to 4 h postoperatively was significant ( p 0.0001). A significantly meaningful correlation was reported between hemoglobin changes and the degree of surgery difficulty with the size of the uterine and fibroids ( p < 0.05). While a negative correlation was found regarding gravidity and surgery difficulty ( r = −0.413, p = 0.02). Surgery duration was longer in Group P compared with Group L 70.66 ± 19.85 versus 66.16 ± 14.48, respectively, but with no significant difference ( p = 0.32). No significant adverse reaction or serious complication was reported in the two groups. Hemodynamic parameters were kept in the normal range throughout the surgery. Conclusion A combination of lidocaine plus epinephrine during abdominal myomectomy appears to be a safe and effective method in reducing blood loss.

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“…9) An incision is made on the myoma surface into the myoma nodule, and the myoma is detached at the border between the myoma nodule and the muscle layer with the peudocapsule. 42) This might result in bleeding, injury to the blood supply, and delayed wound healing, if the myoma nodule detachment was shallow and the pseudocapsule was damaged. It is also important to minimize use of the electrocauterizer in the uterine muscle layer, when enucleation of the myoma nodule has been performed on this layer.…”

Section: Precautions For Uterine Myomectomy and Technical Training Prmentioning

confidence: 99%

Uterine rupture and placenta accreta spectrum following laparoscopic myomectomy in Japan: A message from obstetricians to gynecologic laparoscopists

Takeda

Makino

2019

Hypertens Res Pregnancy

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Laparoscopic myomectomy (LSM) is a procedure often requested by patients because of its minimal invasiveness. This procedure has, therefore, been widely performed in recent years. However, there is a need for more reports from the obstetric field to determine the effects of this procedure on subsequent pregnancies. In this regard, we searched Japanese medical literature databases for articles on Japanese cases of uterine rupture, placenta increta, or placenta percreta in pregnancy following myomectomy. This review article aims to analyze the retrieved data to clarify the issues involved and to provide useful feedback to gynecologists by sharing information with them on such issues.There were 32 cases with available detailed data between 2000 and 2017. There were 7 cases of uterine rupture in pregnancy following laparotomic myomectomy (LTM), comprising 1 full-term case (14.3%), 5 preterm cases (71.4%), and 1 case at 16 gestational weeks (abortion period, less than 22 gestational weeks) (14.3%). On the other hand, there were 25 cases of uterine rupture in pregnancy following LSM, comprising 2 full term cases (8.0%), 18 preterm cases (72.0%), and 5 abortion cases (at 7, 10, 16, 19, and 21 gestational weeks) (20.0%). There was no distinct difference between the frequencies of uterine rupture following LTM and LSM in relation to the abortion period or the preterm period. Cases of uterine rupture following LSM included 3 cases who had undergone subserous myomectomy in which electrocauterization alone was used for resection and hemostasis. In 4 cases, the submucosal myoma had been enucleated, with exposure of the endometrium.Placenta accreta spectrum disorders occurred in the scar region in the following cases: placenta accreta, 7 cases; placenta increta, 3 cases; and placenta percreta, 12 cases. Three cases were described as having myometrial laceration or separation or incomplete uterine rupture. There were 5 cases of complete uterine rupture (at 16, 18, 18, 22, and 37 gestational weeks) accompanied by intraabdominal hemorrhage. In the other 20 cases, incomplete uterine rupture was diagnosed at the time of cesarean section. Total abdominal hysterectomy or Poro's operation was performed in 11 cases during surgery.In comparison with uterine rupture in pregnancy following cesarean section, uterine rupture in pregnancy following myomectomy often occurs at an earlier stage, and thus requires caution. Pregnancies and deliveries after myomectomy carry the risks of uterine rupture and the development of placenta accreta spectrum disorders. Precautions in the management strategies for such pregnancies and deliveries, as well as the gist of the feedback given to gynecologists, are discussed herein.

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Abdominal Myomectomy for Huge Uterine Myomas with Intra-arterial Balloon Occlusion: Approach to Reduce Blood Loss

Cited by 4 publications

References 9 publications

Surgical Management of Uterine Fibroids: About 175 Cases

Surgical Management of Uterine Fibroids: About 175 Cases

Safety and efficacy of lidocaine plus epinephrine on intraoperative bleeding in abdominal myomectomy: A double‐blind clinical trial

Uterine rupture and placenta accreta spectrum following laparoscopic myomectomy in Japan: A message from obstetricians to gynecologic laparoscopists

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