Interventions to reduce haemorrhage during myomectomy for fibroids

Kongnyuy, Eugene J; Wiysonge, Charles Shey

doi:10.1002/14651858.cd005355.pub3

Cited by 80 publications

(117 citation statements)

References 45 publications

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“…Excessive hemorrhage during myomectomy is a major challenge to gynecologic surgeons despite the many procedures used to reduce intraoperative blood loss, blood transfusion for women in abdominal myomectomy (10) . The effects of the interventions used to reduce blood loss during myomectomy have been inconsistent.…”

Section: Discussion:-mentioning

confidence: 99%

See 1 more Smart Citation

A Comparative Study Between Preoperative Use of Misoprostol and Dinoprostone for Reduction of Hemorrhage During Abdominal Myomectomy.

Naggar¹,

Sayed²,

Mohamed³

et al. 2017

IJAR

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Section: Discussion:-mentioning

confidence: 99%

“…It stimulates uterine contractions, and this leads to contraction of the vessels supplying blood to the leiomyomas. This subsequently may redistribute the blood from the diseased uterus back to the circulation, hence reducing operative blood loss during abdominal myomectomy (6,7,8) .…”

Section: Issn: 2320-5407mentioning

confidence: 99%

A Comparative Study Between Preoperative Use of Misoprostol and Dinoprostone for Reduction of Hemorrhage During Abdominal Myomectomy.

Naggar¹,

Sayed²,

Mohamed³

et al. 2017

IJAR

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“…y maximizar el éxito reproductivo futuro. Dentro de ellas están: ubicar los sitios de entrada considerando la necesidad de sutura endoscópica (24), la infiltración local con vasopresina previo a la extirpación del mioma (25)(26)(27), limitar el número de incisiones (longitudinales u oblicuas, pero siempre considerando los reparos anatómicos y el facilitar la sutura posterior del lecho) (5,20,28,29), suturar el miometrio en múltiples planos (especialmente en pacientes con deseo de fertilidad futura) y elegir la vía de extracción dependiendo del caso particular (mioma pequeño: a través del trócar, miomas de mayor tamaño: uso de morcelador o extracción por colpotomía posterior) .…”

Section: Discussionunclassified

Miomectomía Abdominal Versus Miomectomía Laparoscópica: Experiencia Preliminar Del Hospital Clínico De La Pontificia Universidad Católica De Chile

Sigüenza²,

et al. 2009

Rev. chil. obstet. ginecol.

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RESUMENAntecedentes: Múltiples pacientes requieren un manejo conservador del mioma uterino. Muchas de ellas no han completado su paridad, y otras no desean la remoción del útero preocupadas del impacto que esa alternativa tenga en su vida sexual. Objetivos: Evaluar nuestra experiencia en pacientes miomectomizadas mediante laparoscopia o laparotomía y revisar la literatura para definir las ventajas de cada técnica y recomendaciones para su indicación. Método: Estudio prospectivo, no randomizado, de pacientes miomectomizadas en el Servicio de Ginecología del Hospital Clínico de la Universidad Católica de Chile, durante el período noviembre de 2007 y mayo de 2008. Resultados: La población incluida fue de 43 casos; 16 casos correspondieron a miomectomía laparoscópica (37,2%) y 27 a miomectomía por laparotomía (67,8%). La miomectomía por laparotomía se realizó en 40% de los casos utilizando una incisión transversa mínima. Esta vía de abordaje fue más frecuentemente utilizada cuando se trataba de miomas de gran tamaño o de múltiples miomas. En nuestra serie, la miomectomía laparoscópica se asociaría a un menor requerimiento de analgesia. No hay diferencias en la frecuencia de complicaciones, tiempo operatorio y estadía hospitalaria entre ambas técnicas, cuando se trata de miomas operados menores de 5 cm. Conclusión: Nuestros resultados sugieren que la miomectomía por laparotomía es una técnica segura que debiese privilegiarse cuando se trata de miomas grandes y múltiples. La laparoscopia es igualmente segura reservada para casos bien seleccionados y cirujanos experimentados en el procedimiento.PALABRAS CLAVE: Mioma, miomectomía, cirugía, laparoscopia, complicaciones SUMMARY Background: Multiple patients ask for a conservative management of uterine fibroids. Some of the patients have not completed their parity at the time of surgery, and others do not want an hysterectomy worried about de impact of this procedure in their sexual life. Objectives: The objective of this study was to evaluate our experience in the short term surgical results of patients undergoing a laparoscopic or abdominal myomectomy. We also did a literature review to define the advantages for each technique and their indications. Methods: A prospective, non-randomized study comparing short term surgical outcomes in patients undergoing laparoscopic versus abdominal myomectomy in the Gynecology Service of the Clinical Hospital of the Pontificia Universidad Católica de Chile, between November 2007 and May 2008. Results: Forty-three patients undergoing myomectomy in our centre were analyzed. 16 of them were approached by laparoscopy (37.2%)

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“…The ureter was observed closely throughout the procedure. Vasopressin was routinely injected into the broad ligament fibroid to reduce intraoperative bleeding [9]. Depending on the location of the fibroid in relation to the uterine vessels and the ureter, an incision was made on the anterior or posterior leaf of the broad ligament.…”

Section: Operative Techniquementioning

confidence: 99%

Broad ligament fibroids—a radiological and surgical challenge

2014

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Currently, there is limited data on the ease of imaging of broad ligament fibroids and their safe laparoscopic management. We aimed to review all laparoscopic myomectomies over an 8-year period, focusing on intraoperative findings and corresponding pre-operative imaging. All laparoscopic myomectomies performed between 2004 and 2012 were reviewed. Cases with broad ligament fibroids were identified. Presenting symptoms, imaging, intraoperative findings, complications and 6-month follow-up were noted. Ten broad ligament fibroids were identified from 185 cases of laparoscopic myomectomies. Mean broad ligament fibroid diameter was 8.1 cm, and the largest was 15 cm. Mean combined fibroid weight was 267 g (range 30-560 g). Blood loss was associated with the total number of fibroids excised rather than the diameter of the broad ligament fibroid (range 30-400 ml). Accurate pre-operative diagnosis at imaging was made in only one of the ten broad ligament fibroids. Of the remainder, one was thought to be an ovarian mass, one fibroid was missed entirely and seven were reported non-specifically as 'lateral'. This case series indicates the challenge posed by broad ligament fibroids at pre-operative imaging. Underreporting may reflect a lack of awareness of the surgical significance of broad ligament fibroids. There should be a high level of suspicion for location within the broad ligament if a fibroid reported is as lateral. With adequate operator experience, large fibroid size should not contraindicate laparoscopic management of broad ligament fibroids.

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Interventions to reduce haemorrhage during myomectomy for fibroids

Cited by 80 publications

References 45 publications

A Comparative Study Between Preoperative Use of Misoprostol and Dinoprostone for Reduction of Hemorrhage During Abdominal Myomectomy.

A Comparative Study Between Preoperative Use of Misoprostol and Dinoprostone for Reduction of Hemorrhage During Abdominal Myomectomy.

Miomectomía Abdominal Versus Miomectomía Laparoscópica: Experiencia Preliminar Del Hospital Clínico De La Pontificia Universidad Católica De Chile

Broad ligament fibroids—a radiological and surgical challenge

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