Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy

Kotani, Yoshihisa; Tobiume, Takako; Fujishima, Risa; Shigeta, Mamoru; Takaya, Hisamitsu; Nakai, Hidekatsu; Suzuki, Ayako; Tsuji, Isao; Mandai, Masaki; Matsumura, Noriomi

doi:10.1111/jog.13519

Cited by 84 publications

(67 citation statements)

References 16 publications

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“…It is most often offered to patients who desire future fertility but is also considered by those who have completed childbearing and wish to retain their uterus. Myomectomy provides temporary reduction in uterine volume and improvement of symptoms in up to 80% of women but is associated with an approximately 27% risk of recurrence after removal of a single fibroid, and greater than 50% in the case of multiple fibroids . Myomectomies are overall associated with a low rate of complications (1%–5%) .…”

Section: Managementmentioning

confidence: 99%

Epidemiology and management of uterine fibroids

Giuliani

As‐Sanie

Marsh

2020

Intl J Gynecology & Obste

385

286

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Uterine leiomyomas are one of the most common and yet understudied diseases in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African ancestry during their lifetime. This disease has a profound impact on health care delivery and costs worldwide. Though most women with fibroids are asymptomatic, approximately 30% of them will present with severe symptoms which can include abnormal uterine bleeding, anemia, pelvic pain and pressure, back pain, urinary frequency, constipation, or infertility, and will require intervention. Furthermore, fibroids have been associated with poor obstetrical outcomes. The current options for symptomatic fibroid treatment include expectant, medical, and surgical management, and interventional radiology procedures. This article reviews the recent progress and available management strategies for uterine fibroids and highlights areas where further research is needed to find new therapeutic targets and better personalize treatments.

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Section: Managementmentioning

confidence: 99%

Epidemiology and management of uterine fibroids

Giuliani

As‐Sanie

Marsh

2020

Intl J Gynecology & Obste

385

286

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“…In recent years, LM has been increasingly performed because it is minimally invasive and has lower rate of postoperative intraperitoneal adhesions than OM. However, in our previous retrospective study, we reported that the postoperative recurrence rate after LM was significantly higher than that after OM …”

Section: Discussionmentioning

confidence: 74%

“…For LM, once a uterine manipulator had been inserted, a pneumoperitoneum needle was placed through the umbilicus, and pneumoperitoneum was then achieved by using the closed method . Subsequently, the first trocar was inserted through the umbilicus, followed by the laparoscope.…”

Section: Methodsmentioning

confidence: 99%

“…A risk factor for recurrence was the number of myoma removed during the initial operation, with a higher number representing a higher risk . In our previous study, the postoperative recurrence rate after OM was significantly lower than that after LM, although OM patients had more and larger myomas . It is possible that the lack of palpation during surgery led to small myomas being left behind, eventually causing postoperative recurrence .…”

Section: Introductionmentioning

confidence: 91%

“…In our previous study, the postoperative recurrence rate after OM was significantly lower than that after LM, although OM patients had more and larger myomas . It is possible that the lack of palpation during surgery led to small myomas being left behind, eventually causing postoperative recurrence . To reduce residual myomas, we began to perform MRI preoperatively so that we could evaluate the images during surgery .…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of laparoscopic ultrasonography in laparoscopic myomectomy

Shigeta

Kotani

Fujishima

et al. 2019

Asian J Endoscop Surgery

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Introduction Laparoscopic myomectomy (LM) has become increasingly common in recent years because it minimizes invasiveness. However, myoma can recur after myomectomy. Therefore, we began using laparoscopic ultrasonography, which involves inserting a probe into the peritoneal cavity via a trocar and placing it in direct contact with the uterus. During surgery, this enables the detection of myomas as a small as 1 mm in diameter, which are often undetectable on MRI. Here, we report the effectiveness of laparoscopic ultrasonography. Methods The subjects were 26 women who underwent LM at our institution from February 2015 to December 2016. Preoperative MRI was performed, and all myomas detected on MRI were removed during LM. Laparoscopic ultrasonography was then performed to assess for residual myomas, which were removed. Results In six patients (23%), residual myomas were identified on laparoscopic ultrasonography after the first enucleation of the myomas detected on preoperative MRI. All detected residual myomas, the largest of which was less than 10 mm in diameter, were removed. Conclusion Small myomas undetectable on preoperative MRI were detected on laparoscopic ultrasonography and removed.

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Associations between the time interval from myomectomy to subsequent pregnancy and the obstetric outcomes: A population‐based cohort study

Chen,

Ku,

Yang

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth.MethodsA retrospective population‐based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6–11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18–34 vs ≥35 years old).ResultsWe observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22–3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49–14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6–11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14–2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16–9.24, P = 0.025) versus a TIMP of 6–11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17–4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17–3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06–15.53, P = 0.041); whereas women aged 18–34 years old did not.ConclusionsThis study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old.

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Recurrence of uterine myoma after myomectomy: Open myomectomy versus laparoscopic myomectomy

Cited by 84 publications

References 16 publications

Epidemiology and management of uterine fibroids

Epidemiology and management of uterine fibroids

Effectiveness of laparoscopic ultrasonography in laparoscopic myomectomy

Associations between the time interval from myomectomy to subsequent pregnancy and the obstetric outcomes: A population‐based cohort study

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