Laparoscopic myomectomy: predicting the risk of conversion to an open procedure

Dubuisson, Jean‐Bernard; Fauconnier, Arnaud; Fourchotte, Virginie; Babaki‐Fard, Katayoun; Coste, Joël; Chapron, Charles

doi:10.1093/humrep/16.8.1726

Cited by 167 publications

(143 citation statements)

References 27 publications

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“…Timing of medical administration is more critical with GnRH agonists due to the well documented regrowth of fibroids within 3 months; ulipristal acetate treatment produces persistent tumor shrinkage beyond this time. Preoperative use of GnRH agonists is associated with a softening of the UF and destruction of tissue planes for myomectomy 89,90 ; it is unclear whether pre-surgical use of ulipristal acetate is associated with the same drawback.…”

Section: Pre-surgical Medical Approachesmentioning

confidence: 99%

Contemporary management of uterine fibroids: focus on emerging medical treatments

Singh

Belland

2014

Current Medical Research and Opinion

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Section: Pre-surgical Medical Approachesmentioning

confidence: 99%

Contemporary management of uterine fibroids: focus on emerging medical treatments

Singh

Belland

2014

Current Medical Research and Opinion

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“…One study suggests a risk estimation model for conversion to laparotomy. Dubuisson et al [16] proposed 4 preoperative factors independently related to the risk of conversion: a size of 50 mm on ultrasonography, intramural type, anterior location, and preoperative use of GnRH agonists. Careful patient selection and expertise of the operating team are mandatory for success of laparoscopic Fig.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cervical myomectomy: Five years of experience

이수윤

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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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“…2 Laparoscopic surgery requires surgeons to have more training and experience, and procedures for large or multiple myomas may take more time and cause more intra-operative bleeding compared with conventional laparotomy. 14 Previous studies have suggested limiting conventional laparoscopic myomectomy to patients with ≤ 3 myomas, each measuring < 6 cm 4,5,11 or 8 -10 cm in diameter. 15 With myomas > 5 cm or those located in the anterior uterine wall there is an increased risk (1 -5) P = 0.032 median (range) Intra-operative blood loss, ml, 80 (40 -500) 100 (50 -1200) P = 0.044 median (range) Patients requiring transfusion, n 0 6 P = 0.000 a Mann-Whitney U-test.…”

Section: Discussionmentioning

confidence: 99%

Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial

Yang

Gao

et al. 2011

J Int Med Res

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In a single-centre, randomized trial, gasless laparoscopic myomectomy was compared with conventional laparoscopic myomectomy. The study examined feasibility, safety, reliability and post-operative outcomes. Estimated blood loss, duration of surgery, early post-operative outcomes and length of hospital stay were recorded. Compared with conventional laparoscopic myomectomy, gasless laparoscopy resulted in significantly lower intra-operative blood loss (median 100 ml vs 80 ml, respectively) and duration of surgery (median 94 min vs 71 min, respectively). Post-operative abdominal drainage volume was significantly lower after gasless laparoscopy than after conventional laparoscopy (median 100 ml vs 240 ml). There was no significant difference between duration of post-operative fever, post-operative time to flatus or length of hospital stay. Both forms of laparoscopy are suitable for uterine myomectomy, and comparison of these methods showed that gasless laparoscopy had potential advantages over conventional laparoscopy.

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Laparoscopic myomectomy: predicting the risk of conversion to an open procedure

Abstract: This prediction model provides a useful tool that enables multiple criteria to be taken into account simultaneously to help select cases for LM. GnRH agonists should been used only in selected cases. US evaluation is essential before performing LM.

Cited by 167 publications

References 27 publications

Contemporary management of uterine fibroids: focus on emerging medical treatments

Contemporary management of uterine fibroids: focus on emerging medical treatments

Laparoscopic cervical myomectomy: Five years of experience

Gasless Laparoscopy versus Conventional Laparoscopy in Uterine Myomectomy: A Single-Centre Randomized Trial

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