Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy

Seracchioli, Renato; Rossi, Stefania; Govoni, F.; Rossi, Elisa; Venturoli, Stefano; Bulletti, Carlo; Flamigni, Carlo

doi:10.1093/humrep/15.12.2663

Cited by 411 publications

(269 citation statements)

References 24 publications

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“…Laparoscopic removal of the large fibroid using the electromechanical technique 38 makes the procedure less demanding and time consuming. Indeed, our data show a shorter mean operative time than those reported by other authors 8,10 in the presence of fibroids penetrating the uterine cavity, and may be comparable to abdominal myomectomy 39 .…”

Section: Discussionsupporting

confidence: 76%

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Seracchioli

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective The purpose of the study was to evaluate the post-operative course and follow up of women who had undergone laparoscopic removal of intramural fibroids penetrating the uterine cavity. Design Retrospective study.Setting Center for Reconstructive Pelvic Endosurgery, Italy.Population Thirty-four women with fibroids penetrating the uterine cavity. Methods Laparoscopic myomectomy.Main outcome measures Feasibility and safety of surgical technique, length of operation, blood loss, intraor post-operative complications, length of hospital stay, resolution of symptoms and future obstetric outcome. Results The mean operative time was 79 (SD 30) minutes; the mean reduction in haemoglobin was 1.1 F 0.9 g/dL. No intra-or post-operative complications were observed. The average post-operative stay in hospital was 54 (SD 22) hours. Nineteen (73%) out of 26 patients who had experienced symptoms prior to surgery reported resolution of these symptoms post-operatively. All patients resumed work within a mean time of 20 (SD 8) days. Among 23 of the 32 patients attempting pregnancy during the follow up period, nine (39%) conceived within one year. Seven pregnancies went to term without complications. Conclusion The clinical results of this study suggest that laparoscopic myomectomy for intramural fibroids penetrating the uterine cavity is a safe procedure, providing well known advantages of minimal access surgery.

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Section: Discussionsupporting

confidence: 76%

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Seracchioli

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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“…In most cases of red degeneration, ultrasound findings reveal cystic spaces in the myomas. 11 Although medical therapy -including analgesics, fluids and antibiotics may be used in the majority of these patients. In patients with severe abdominal pain or an increase in myoma size causing abdominal pain and discomfort, a timely and well-planned myomectomy should be an option.…”

Section: Discussionmentioning

confidence: 99%

A Rare Surgery: Myomectomy on Pregnant Uterus

U¹,

Patel²,

K³

2015

jemds

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BACKGROUND: Leiomyomas also called myomas or fibroids; are benign monoclonal uterine myometrial tumors. Uterine fibroids are the commonest benign tumours of female genital tract with a prevalence of 20 to 50% in women of reproductive age. Fibroids may be classified as submucous, intramural or sub-serous. It is often assumed that fibroids cause infertility since pregnancies do occur after myomectomy and other treatments where the fibroids are removed. The treatment of fibroids has historically been surgery, usually hysterectomy. Myomectomy is an option in women wishing to maintain fertility and for those desiring to keep their uterus. The position of the uterine fibroid plays important role in infertility. The presence of sub-mucous fibroid decreases the fertility rate. Subserosal fibroids do not affect the fertility rate but removing those does increase fertility. Surgical management is limited to non-pregnant uterus. Fibroid coexisting pregnancy, prevalence is 0.3-2.6%, can be associated with complication in 10 to 30% cases which are managed conservatively. We present a case of multiple fibroid complicating pregnancy with one huge sub-serosal pedunculated fibroid extending up to xiphisternum that necessitated myomectomy at 18 to 20 weeks of gestation.

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“…However, more recent studies suggest that laparoscopic myomectomy can be a good alternative method to laparotomy for the treatment of myomas. Seracchioli et al [8,9] reported less morbidity and faster recovery in the laparoscopy group in a randomized trial that compared the results of myomectomy performed using laparotomy and laparoscopy. The incidences of miscarriage, preterm labor, and uterine rupture were similar for laparoscopic myomectomy in several studies.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cervical myomectomy: Five years of experience

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)

조연진

et al. 2012

Korean J Obstet Gynecol

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Uterine myoma is the most common benign tumor in women of reproductive age [1]. Leiomyoma affects 25% to 50% of women of reproductive age, and at least 50% of patients have significant symptoms [2]. Common symptoms of myoma include menorrhagia, metrorrhagia, dysmenorrhea, and pressure symptoms. The process of myoma development is not well understood and can continue until menopause. Indications for surgery include abnormal uterine bleeding, unresponsiveness to medical therapy, pain or pressure symptoms, urinary signs or symptoms, a high level of malignancy, growth after menopause, infertility with endometrial distortion, and recurrent pregnancy loss [1]. For preservation of fertility, myomectomy is carried out in women of reproductive age with symptomatic uterine myoma. With the development of laparoscopic equipment and establishment of laparoscopic surgical settings, the indications for gynecologic laparoscopy have been extended. Nowadays, laparoscopic operation is generally preferred because of its good cosmetic results, reduced pain levels, short hospitalization time, quick recovery time, and similar outcomes as those of laparotomy [3]. LAPAROSCOPIC CERVICAL MYOMECTOMY: FIVE YEARS OF EXPERIENCE ObjectiveThis retrospective case series evaluated the feasibility and safety of laparoscopic cervical myomectomy. MethodsSixty-five patients with cervical myoma who underwent laparoscopic cervical myomectomy were included in this study. ResultsThe mean age of the patients was 39.2 ± 6.0 years. The marriage rate was 67.7%, and the mean parity was 1.09. The most common symptoms in the patients were increased myoma size (41.5%) and menorrhagia (13.8%), while 20% of patients were asymptomatic. The average diameter of the myomas treated was 72.68 ± 20.28 mm, and the mean number of myomas per patient was 1.41± 0.88. Laparoscopic cervical myomectomy required a mean time of 63.25 ± 20.34 minutes. The difference between preoperative and postoperative hemoglobin levels was 2.01± 0.73 g/dL, and no patient required transfusion or conversion to laparotomy. ConclusionSixty-five procedures of laparoscopic cervical myomectomy were performed safely. Operation time and complications were minimal. With correct understanding of pelvic anatomy, laparoscopic cervical myomectomy can be carried out safely and easily, and represents a minimally invasive treatment choice for symptomatic cervical myoma.

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Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy

Cited by 411 publications

References 24 publications

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

A Rare Surgery: Myomectomy on Pregnant Uterus

Laparoscopic cervical myomectomy: Five years of experience

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