Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience

Saccardi, Carlo; Gizzo, Salvatore; Noventa, Marco; Ancona, E.; Borghero, Angela; Litta, Pietro

doi:10.1007/s00404-014-3289-2

Cited by 51 publications

(40 citation statements)

References 38 publications

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“…It is an appropriate, if not preferred, alternative to abdominal myomectomy in well-selected patients since it offers shorter hospitalization, short recovery period and resumption of activities within 1–2 weeks, reduced risk of blood transfusion, and intraoperative adhesions. [ 1 2 3 ] Most frequent complications independent from surgeon's experience remain to be massive intraoperative bleeding and conversion to hysterectomy. [ 1 ] The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate.…”

Section: Introductionmentioning

confidence: 99%

Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience

Martinez

Domingo

2018

Gynecol Minim Invasive Ther

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Background:Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM.Methodology:Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed.Results:There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010).Conclusion:LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.

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Section: Introductionmentioning

confidence: 99%

Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience

Martinez

Domingo

2018

Gynecol Minim Invasive Ther

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“…application of vasoconstrictive agents, hemostatics, barbed sutures or mechanical maneuvers [16–21]), the average intraoperative blood loss during LM is between 100 and 450 ml (ranging from 20 to 2000 ml) [7, 10, 14, 16, 21, 22] and can be higher as in laparoscopic hysterectomy for similar indications [15]. …”

Section: Introductionmentioning

confidence: 99%

“…Yoo and Lee [25] identified patient’s age, more than 5 intramural fibroids, myoma diameter > 8.2 cm, posterior wall localization, concomitant adenomyosis and previous pelvic-abdominal surgery as risk factors for discontinuation of a laparoscopic procedure and conversion to laparotomy. According to Saccardi et al [22], diameter and type (intramural vs. subserosal) of the myomas were the best predictors of blood loss and surgical time in LM. Walid and Heaton [9] identified solely the myoma diameter as the main predictor of blood loss in LM.…”

Section: Introductionmentioning

confidence: 99%

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

Watrowski

Jäger

Förster

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic myomectomy (LM) can be associated with significant bleeding.AimTo identify factors influencing the postoperative hemoglobin (Hb) drop after LM.Material and methodsThis is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015.ResultsThe median age of the patients was 37 (23–53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5–12) cm. The mean surgical time was 83 ±38 (35–299) min. The median number of sutures was 3 (1–11). The mean postoperative Hb drop was 1.6 ±1.2 (0–6) g/dl, and the mean estimated blood loss was 261 ±159 (50–1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients’ age or number of intramural myomas. In the multivariable analysis, the surgical time (β = 0.395, p < 0.001), diameter of the largest myoma (β = 0.292, p = 0.03) and preoperative Hb concentration (β = 0.299, p < 0.001) predicted the postoperative Hb change.ConclusionsSurgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.

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“…A variety of therapeutic options are available for submucous myomas, such as myomectomy (using laparotomic, laparoscopic or hysteroscopic access), subtotal or total hysterectomy (by laparotomy or laparoscopy). With the popularization of the concept of the minimal-access surgical techniques, hysteroscopic and laparoscopic operations have predominated in recent years [ 9 – 11 ]. Currently, it is possible to treat symptomatic submucosal myomas less invasively, with good results, with hysteroscopic myomectomy [ 5 , 12 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

The indication and curative effect of hysteroscopic and laparoscopic myomectomy for type II submucous myomas

Wang¹,

Zhao²,

Li³

et al. 2016

BMC Surg

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BackgroundThe aim of this study was to assess curative effect of hysteroscopic and laparoscopic myomectomy for type II submucous myomas between 3 and 5 cm in diameter and explore the optimal surgical indications.MethodsA retrospective analysis was performed of those who underwent hysteroscopic or laparoscopic myomectomy from January 2008 to January 2013. The patients were divided into three subgroups according to the myomas diameter (namely, 30 mm ≤ myomas diameter <40 mm; 40 mm ≤ myomas diameter <50 mm; and myomas diameter ≥ 50 mm). Clinical data such as operation time, amount of bleeding, postoperative anal exsufflation time, hospital stay, and complications were collected.ResultsThere was no significant difference regarding operation time and amount of bleeding in two groups. We found significant difference in hysteroscopic group (within-subgroup) difference regarding operation time and amount of bleeding, whereas no significant difference in the laparoscopic group, while significant differences between-subgroup differences regarding operation time. Complete removal of myoma was seen in all patients.ConclusionsBoth techniques are feasible for type II submucous myomas. Laparoscopic operation has higher advantages in type II submucous myomas of greater than 4 cm in diameter whereas hysteroscopic operation has higher advantages in type II submucous myomas of lower than 4 cm in diameter.

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Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience

Cited by 51 publications

References 38 publications

Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience

Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

The indication and curative effect of hysteroscopic and laparoscopic myomectomy for type II submucous myomas

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