Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas

Alessandri, Franco; Lijoi, Davide; Mistrangelo, Emanuela; Ferrero, Simone; Ragni, Nicola

doi:10.1016/j.jmig.2005.11.008

Cited by 157 publications

(147 citation statements)

References 18 publications

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“…Laparotomic myomectomy should be considered the traditional surgical treatment in patients of the childbearing age [6]. Nevertheless, laparoscopic management could be a valid alternative to laparotomic approach, with substantial advantages, such as reduction of postoperative pain and hospital stay, drop of blood loss and better cosmetic results of surgical scars [7-12]. Also, transvaginal hydrolaparoscopy has proved itself to be a procedure that reduces the postoperative adhesions and fibrous connection adhesion; in fact, it is less traumatic than traditional laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Gardella

Dominoni

Iacobone

et al. 2018

Gynecol Obstet Invest

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Background: This work analyzes the feasibility and effectiveness of barbed suture during laparoscopic myomectomy. Methods: Eight works have been carefully examined for the meta-analysis from all papers published online until November 2017. Results: Barbed suture proved to be superior to traditional suture technique in blood loss in laparoscopic myomectomy (Standardized Mean Difference [SMD] –0.650, 95% CI –1.420 to –0.119, p = 0.098, test for heterogenity p < 0.0001, I² = 95.54%), Hb drop (SMD –1.452, 95% CI –3.590 to 0.687, p = 0.183, test for heterogenity p < 0.0001, I² = 99.08%), suturing difficulty (SMD –0.638, 95% CI –0.935 to –0.342, p ≤ 0.001, test for heterogenity p = 0.25, I² = 27.84%), suturing time (SMD –1.197, 95% CI –1.848 to –0.549, p ≤0.001, test for heterogenity p = 0.0001, I² = 83.30%) and total operative time (SMD –0.687, 95% CI –0.804 to –0.569, p ≤ 0.001, test for heterogenity p = 0.292, I² = 17.44%). Barbed suture demonstrated to be better in comparison with the control group even with regard to the length of hospitalization (SMD –0.278, 95% CI –0.543 to 0.012, p = 0.040, test for heterogenity p = 0.025, I² = 61.85%), and to perioperative complications (SMD 0.708, 95% CI 0.503–0.996, p = 0.048, test for heterogenity p = 0.79, I² = 0%). Conclusion: Barbed suture significantly facilitates laparoscopic myomectomy by reducing the total operative/suturing time, estimated blood loss/Hb drop, and reduction of perioperative complications.

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Section: Introductionmentioning

confidence: 99%

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Gardella

Dominoni

Iacobone

et al. 2018

Gynecol Obstet Invest

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“…Myomectomy, if done by laparotomy, may be associated with postoperative complications among many patients; however, the vast majority of these complications, such as pyrexia (reported by 33.5% of patients), are rarely serious 10 . Although most myomectomies were originally performed by laparotomy, endoscopic options (laparoscopy/hysteroscopy) are associated with reduced blood loss, reduced patient pain and analgesic use, and a quicker recovery 104 . However, laparotomy may be preferred for UFs that are larger, more numerous, or intramurally located 53,54 .…”

Section: Surgical and Interventional 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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“…Rapid morcellation with a scalpel and removal of large volumes of tissue through the ultra-minilaparotomy incision obviates many of the time-consuming technical demands of laparoscopic myomectomy and results in decreased operating time and blood loss [31] . The presence of a submucosal myoma was one of the exclusion criteria as Fanfani et al [32] and Alessandri et al [12] described. In our study, we also treated 5 (6%) intramural-submucosal myomas (G1) in 4 patients.…”

Section: Discussionmentioning

confidence: 99%

“…One 5-mm port (surgeon's side) and one 10-mm port (contralateral side) were inserted for the introduction of the surgical instruments. A uterine manipulator was used to permit anteversion, lateral uterine movements and organ exposure [11,12] . While pneumoperitoneum was being created, the minilaparotomic incision was performed, as in the ultra-minilaparotomy procedure.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Ultra-Minilaparotomy Myomectomy: A Minimally Invasive Surgical Approach for the Treatment of Large Uterine Myomas

Ciavattini

Tsiroglou²,

Litta³

et al. 2009

Gynecol Obstet Invest

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Background: In recent years, a growing number of more conservative methods for the treatment of uterine myomas has been reported. However, only a small number of techniques is used for the treatment of large myomas. Aims: In the present retrospective study, we report our experience with a group of patients who consecutively underwent ultra-minilaparotomy myomectomy for single or multiple large myomas, with diameter greater than 5 cm, with emphasis on the safety and efficacy of this procedure. Methods: Forty-one women underwent an ultra-minilaparotomy myomectomy that involved a <4 cm transverse skin incision, with or without laparoscopic assistance. Results: Mean operating time was 92.4 min, the mean hemoglobin decline was 2.0 g/dl and the mean hematocrit decline was 5.7%. The mean time to discharge was 84.3 h. No patient underwent a second surgery for early postoperative complications. Postoperative fever occurred in 4 patients, especially in patients who underwent ultra-minilaparotomy without assisted laparoscopy. There were two cases of severe anemia with recourse to blood transfusion. Conclusion: The results of this study suggest that ultra-minilaparotomy myomectomy with or without laparoscopic assistance might represent a safe and effective minimally invasive alternative to standard open myomectomy in the treatment of large myomas.

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Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas

Cited by 157 publications

References 18 publications

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

Contemporary management of uterine fibroids: focus on emerging medical treatments

Ultra-Minilaparotomy Myomectomy: A Minimally Invasive Surgical Approach for the Treatment of Large Uterine Myomas

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