Adhesion formation after intracapsular myomectomy with or without adhesion barrier

Tinelli, Andrea; Malvasi, Antonio; Guido, Marcello; Tsin, Daniel A.; Hudelist, Gernot; Hurst, Bradley S.; Stark, Michael; Mettler, Liselotte

doi:10.1016/j.fertnstert.2010.12.049

Cited by 76 publications

(49 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16,32,33,47 Since adhesion formation following myomectomy may reduce fertility, formal secondlook laparoscopic studies in nonpregnant women following RALM may be needed for a more definitive measure of postoperative adhesion formation. A limitation of our study is the inability to generalize these findings to other practices.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Jetty¹

2015

WJOLS

View full text Add to dashboard Cite

Review study question: What are the characteristics of the pregnancy outcomes in women undergoing robot-assisted laparoscopic myomectomy (RALM) for symptomatic leiomyomata uteri?Summary answer: Despite a high prevalence of women with advanced maternal age, obesity and multiple pregnancy, the outcomes are comparable with those reported in the literature for laparoscopic myomectomy. Study design: Review study.Participants/material, setting, methods: An extensive search for articles related to the topic and review the studies. Main results:The mean time to conception was 12 to 18 months. Assisted reproduction techniques were employed in 22 to 24% of these women. Spontaneous abortions occurred in 18 to 20%. Preterm delivery prior to 35 weeks of gestational age occurred in 17%. One uterine rupture was documented in all studies together. Pelvic adhesions were discovered in 11 to 16% of patients delivered by cesarean section. Higher preterm delivery rates were significantly associated with a greater number of myomas removed and anterior location of the largest incision. None of the myoma characteristics were related to spontaneous abortion.

show abstract

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Jetty¹

2015

WJOLS

View full text Add to dashboard Cite

show abstract

“…Filmy and organized adhesions were predominantly treated with an adhesion barrier and cohesive adhesions were more common without an ad hesion barrier (p < 0.05). Finally, blood loss is lower in laparoscopic intracapsular myomectomy [37]. For these reasons, an adhesion barrier should be used for laparoscopic myomectomy, even when using an intracapsular method.…”

Section: Fibroid Neurovascular Bundlementioning

confidence: 99%

Neurovascular bundle in fibroid pseudocapsule and its neuroendocrinologic implications

Mettler

Tinelli²,

Hurst

et al. 2011

Expert Review of Endocrinology & Metabolism

Self Cite

View full text Add to dashboard Cite

The myoma pseudocapsule is a surgical-anatomical entity surrounding the fibroid that separates the myoma from normal uterine tissue. The myoma pseudocapsule has a delicate vascular network rich with neurotransmitters analogous to the neurovascular bundle surrounding the prostate. The pseudocapsule neurovascular bundle is extremely important during myomectomy to promote uterine myometrial healing and, consequently, for uterine reproductive function. New advancements in surgery, including the use of laparoscopic myomectomy by an intracapsular technique and magnification of the myoma pseudocapsule to enhance visualization are comparable to the dissection during a radical prostatectomy. Fibroid detachment occurring inside the pseudocapsule causes less bleeding, spares the neurovascular bundle and promotes better uterine healing. The maintenance of myometrial integrity after laparoscopic myomectomy maintains uterine function and therefore improves reproductive outcomes, including labor.

show abstract

“…Myomectomy, though allowing for uterine preservation, does require one or more myometrial incisions; can require a postprocedural inpatient hospitalization similar to that of hysterectomy; and may be associated with increased blood loss, longer procedure times, and increased risk for postoperative hemorrhage and/or pelvic adhesions. 16,17 Interventional radiologists have achieved symptom improvement and fibroid tumor shrinkage through embolization of the uterine arteries. 16,18 Laparoscopic bipolar coagulation of uterine vessels and uterine nerves has been reported.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Radiofrequency Fibroid Ablation: Phase II and Phase III Results

Galen¹,

Pemueller

Leal³

et al. 2014

JSLS

View full text Add to dashboard Cite

Background and Objectives:To review phase II and phase III treatments of symptomatic uterine fibroids (myomas) using laparoscopic radiofrequency volumetric thermal ablation (RFVTA).Methods:We performed a retrospective, multicenter clinical analysis of 206 consecutive cases of ultrasound-guided laparoscopic RFVTA of symptomatic myomas conducted on an outpatient basis under two phase II studies at 2 sites (n = 69) and one phase III study at 11 sites (n = 137). Descriptive and exploratory, general trend, and matched-pair analyses were applied.Results:From baseline to 12 months in the phase II study, the mean transformed symptom severity scores improved from 53.9 to 8.8 (P < .001) (n = 57), health-related quality-of-life scores improved from 48.5 to 92.0 (P < .001) (n = 57), and mean uterine volume decreased from 204.4 cm3 to 151.4 cm3 (P = .008) (n = 58). Patients missed a median of 4 days of work (range, 2–10 days). The rate of possible device-related adverse events was 1.4% (1 of 69). In the phase III study, approximately 98% of patients were assessed at 12 months, and their transformed symptom severity scores, health-related quality-of-life scores, mean decrease in uterine volume, and mean menstrual bleeding reduction were also significant. Patients in phase III missed a median of 5 days of work (range, 1–29 days). The rate of periprocedural device-related adverse events was 3.5% (5 of 137). Despite the enrollment requirement for patients in both phases to have completed childbearing, 4 pregnancies occurred within the first year after treatment.Conclusions:RFVTA does not require any uterine incisions and provides a uterine-sparing procedure with rapid recovery, significant reduction in uterine size, significant reduction or elimination of myoma symptoms, and significant improvement in quality of life.

show abstract

Adhesion formation after intracapsular myomectomy with or without adhesion barrier

Cited by 76 publications

References 30 publications

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Neurovascular bundle in fibroid pseudocapsule and its neuroendocrinologic implications

Laparoscopic Radiofrequency Fibroid Ablation: Phase II and Phase III Results

Contact Info

Product

Resources

About