Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

Tinelli, Andrea; Malvasi, Antonio; Hurst, Bradley S.; Tsin, Daniel A.; Dávila, Fausto; Domı́nguez, Gema; Dell'Edera, Domenico; Cavallotti, Carlo; Negro, Roberto; Gustapane, Sarah; Teigland, Chris M.; Mettler, Liselotte

doi:10.4293/108680812x13291597716302

Cited by 51 publications

(42 citation statements)

References 55 publications

(67 reference statements)

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“…Recent evidence suggests intracapsular myomectomy (robot-assisted Bnanosurgery^) preserving the neurovascular bundle and neurotransmitters surrounding the fibroids leads to better healing of myometrium, minimal adhesion, and good postoperative scar integrity [70].…”

Section: Robotic Myomectomymentioning

confidence: 99%

Endoscopic Treatment and Power Morcellation of Uterine Fibroids

Dixit

Jesner

Modarres

2016

Curr Obstet Gynecol Rep

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Although a variety of pharmacological and radiological treatment options are available, surgery in the form of myomectomy or hysterectomy provides a quick and effective relief of many symptoms, albeit with attendant surgical risks. In this article, we discuss endoscopic surgical treatments, their relative benefits, and their risks, including risk of morcellation. Patient selection and preoperative preparation for various surgical approaches is discussed. Overall, the evidence base for surgical treatments, including endoscopic, is weak, and, therefore, a pragmatic approach is outlined.

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Section: Robotic Myomectomymentioning

confidence: 99%

Endoscopic Treatment and Power Morcellation of Uterine Fibroids

Dixit

Jesner

Modarres

2016

Curr Obstet Gynecol Rep

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“…Com pres sion of the myometrium dur ing fibroid growth causes its for ma tion. Pseudocapsule is a neurofibrovascular struc ture sur round ing fib roids and con tain ing many neuropeptides and neurotransmitters, ex tremely im por tant ei ther for myometrial func tion al ity or for fer til ity 23,24 .…”

Section: Intracapsular Myomectomymentioning

confidence: 99%

“…This method spares the pseudocapsule as an im por tant struc ture for op ti mal myometrial heal ing af ter myomectomy, pos i tively af fecting fu ture re pro duc tive func tion, la bor and de liv ery. Apart from fi broid pseudocapsule spar ing, this tech nique avoids the use of ischemic so lu tion into myometrium and ex ten sive diathermocoagulation with high elec tri cal wattage (>30 watts), al low ing the nor mal heal ing of the uterine scar 24,25 . All these should min i mize the risk of uter ine rup ture in sub se quent preg nancy and de liv ery 25 .…”

Section: Intracapsular Myomectomymentioning

confidence: 99%

Conservative surgical treatment of uterine fibroids

Sparić¹,

Nejković²,

Mutavdzic

et al. 2014

ACTA CHIR IUG

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Fibroids are the most common benign tumours of the genital organs in women of childbearing age, causing significant morbidity and largely disturbing quality of life. Myomectomy is a option of choice for women who want to preserve reproductive function. Conventional myomectomy via laparotomy is commonly used for large subserosal and intramural fibroids and in cases of a large number of fibroids. Number, size and location of fibroids in most cases do not represent a limiting factor for conventional myomectomy. Vaginal myomectomy is possible in cases of nascent submucosal fibroids. Laparoscopic myomectomy is an option for patients with smaller uterus, as the size of the uterus could represent a limiting factor for this approach. Hysteroscopic resection of submucosal fibroids is the method of choice for most patients with submucous fibroids. There is no consensus yet on the maximum size and type of fibroids that can be operated with this approach. Myoma pseudocapsule research during the past decade led to introduction of a surgical technique called "intracapsular myomectomy", as a method which spares the pseudocapsule as an important structure for optimal myometrial healing after myomectomy, positively affecting future reproductive function. The clinical rationale for intracapsular myomectomy can be applied to all myomectomies, therefore it has been used both for laparoscopic and laparotomic myomectomy, as well as for cesarean myomectomy. Several studies demonstrated that CM is probably safer procedure than previously believed. CM is justifiable when performed following proper patient selection by experienced surgeons.

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“…Surgical treatments, including hysterectomy and myomectomy, have been considered the preferred treatments for uterine fibroids over decades . However, surgery is invasive and not suitable for patients with a fertility desire because of the risk of postoperative recurrence, uterine scarring, and uterine rupture during pregnancy . Recently, high‐intensity focused ultrasound (HIFU) ablation, which is characterized by noninvasiveness, limited adverse effects and complications, and retainment of organ integrity, has shown safety and efficacy in the treatment of uterine fibroids .…”

mentioning

confidence: 99%

“…4,5 However, surgery is invasive and not suitable for patients with a fertility desire because of the risk of postoperative recurrence, uterine scarring, and uterine rupture during pregnancy. [6][7][8][9] Recently, high-intensity focused ultrasound (HIFU) ablation, which is characterized by noninvasiveness, limited adverse effects and complications, and retainment of organ integrity, has shown safety and efficacy in the treatment of uterine fibroids. [10][11][12] However, HIFU therapy is not applicable to all types of uterine fibroids with heterogeneous structural and functional features.…”

mentioning

confidence: 99%

Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

Wang

Zhang

et al. 2018

J of Ultrasound Medicine

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Objectives To assess the predictive significance of quantitative perfusion parameters from contrast‐enhanced ultrasound (CEUS) for the therapeutic response to high‐intensity focused ultrasound (HIFU) ablation in patients with uterine fibroids. Methods A total of 263 patients with single uterine fibroids were treated with HIFU ablation under ultrasound guidance. The arrival time, peak time, enhancement time, enhancement intensity, and enhancement rate were evaluated with pretreatment CEUS. According to a nonperfused volume ratio evaluation by posttreatment magnetic resonance imaging, all patients were assigned to groups with volume ratios of 70% or higher and lower than 70%. Then the predictive performances of different parameters for ablation efficacy were studied. Results The arrival time, peak time, and enhancement time in the group with a nonperfused volume ratio of 70% or higher were longer than those in the group with a volume ratio lower than 70% (mean ± SD, 16.7 ± 3.5, 26.5 ± 4.9, and 10.2 ± 2.6 seconds, respectively, versus 13.3 ± 4.2, 20.8 ± 5.4, and 7.6 ± 2.3 seconds), whereas patients with a volume ratio of 70% or higher had a lower mean enhancement intensity and enhancement rate than those with a volume ratio lower than 70% (29.7 ± 16.7 dB and 3.2 ± 1.5 dB/s versus 63.2 ± 26.3 dB and 8.6 ± 4.3 dB/s; P < .05). The nonperfused volume ratio was negatively correlated with the enhancement intensity and enhancement rate (r = –0.631 and –0.712) but positively correlated with the arrival time, peak time, and enhancement time (r = 0.322, 0.456, and 0.477; P < .05). The areas under the receiver operating characteristic curve for the enhancement time, enhancement intensity, and enhancement rate were 0.73, 0.79, and 0.81 (P < .05). Conclusions Quantitative parameters from CEUS are potentially useful for evaluating the therapeutic effect of HIFU ablation for uterine fibroids.

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Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

Abstract: The authors propose that intracapsular myomectomy be recommended to maximize the potential for future fertility and to minimize the risk of labor dystocia or uterine rupture during pregnancy or labor.

Cited by 51 publications

References 55 publications

Endoscopic Treatment and Power Morcellation of Uterine Fibroids

Endoscopic Treatment and Power Morcellation of Uterine Fibroids

Conservative surgical treatment of uterine fibroids

Predictive Value of Quantitative Uterine Fibroid Perfusion Parameters From Contrast‐Enhanced Ultrasound for the Therapeutic Effect of High‐Intensity Focused Ultrasound Ablation

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