Myomectomy at Cesarean Delivery in Aba, Southeastern Nigeria

Abstract

conventional laparoscopic surgical treatments for endometriosis performed by one surgeon experienced in both techniques. Included were all patients treated between July 2009 and October 2012 for endometriosis stage III or IV (American Society for Reproductive Medicine criteria). Compared between robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups were median age, body mass index, race, extent of surgery, median estimated blood loss, operating room time, length of stay, and intraoperative and postoperative complications. For continuous variables, medians and first and third quartiles were calculated; medians were compared with the Wilcoxon rank-sum test. Distributions of categorical variables were compared with x 2 or Fisher's exact tests. All analyses were two-sided with P,.05 considered significant.RESULTS: Included were 86 conventional laparoscopic surgery and 32 robotic-assisted laparoscopic surgery cases. Compared with the patients undergoing conventional laparoscopic surgery, those who underwent robotic-assisted laparoscopic surgery had a higher body mass index (27.36 kg/m 2 [23.90-34.09 kg/m 2 ] compared with 24.53 kg/m 2 [22.27-26.96 kg/m 2 ]; P,.008; Table 1) and operating room time (250.50 [176-328.50] compared with 173.50 [123-237] minutes; P,.001; Table 2). No significant differences were noted between the robotic-assisted laparoscopic surgery and conventional laparoscopic surgery groups in age, race, hysterectomy rate, estimated blood loss, length of stay, or in rates of intraoperative or postoperative complications.CONCLUSIONS: Despite a higher mean operating room time in the robotic-assisted laparoscopic surgery group, implementation of this new technology might allow a safe minimally invasive surgical approach for obese patients with all other clinical outcomes comparable to those in nonobese patients undergoing conventional laparoscopic surgery.

Myomectomy After a Vaginal Delivery to Treat Postpartum Hemorrhage Resulting From an Intracavitary Leiomyoma

“…11 Simsek and Umezurike reported longer surgical times, increased blood loss, and longer hospital stay in patients undergoing cesarean myomectomy, but did not have any serious complications and concluded that overall myomectomy is safe during cesarean delivery. 10,12 None of the previously described studies reported any major morbidity, and there were no hysterectomies or deaths reported. Song published a metaanalysis of nine studies including 1,082 women with leiomyomas during pregnancy and found a 0.30-g/dL larger drop in hemoglobin in those undergoing myomectomy during cesarean delivery, a nonsignificant difference.…”

“…3 There have been a number of case reports supporting the feasibility of myomectomy at the time of cesarean delivery. [4][5][6][7][8][9][10][11][12] These reports focus on elective myomectomy but do not comment on the use of myomectomy to treat postpartum hemorrhage resulting from the cavity distortion by uterine leiomyomas. Furthermore, in our search of the literature (PubMed from 1966 to June 5, 2014; search terms: postpartum myomectomy, pregnancy AND fibroid, cesarean myomectomy), we found only one report of myomectomy after vaginal delivery.…”