The role of laparoscopic myomectomy in the management of uterine fibroids

Walid, M. Sami; Heaton, Richard L.

doi:10.1097/gco.0b013e328348a245

Cited by 51 publications

(23 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prevalence of myomas within this specific population of women is 20–50%. [1] Within the infertile population, the incidence of myomas has been reported to be 5–10%; indeed, it has been reported that myomas serve as the sole factor underlying infertility in 1–2.4% of cases. [234]…”

Section: Introductionmentioning

confidence: 99%

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Tian

Wang

et al. 2017

Chinese Medical Journal

View full text Add to dashboard Cite

Background:The relationship between intramural myomas and fertility remains unclear. The main debate rests on whether cavity-distorting intramural myomas (CDMs) adversely affect fertility more than non-CDMs. We aimed to compare the effects of enucleating non-CDMs and CDMs on fertility improvement in females with unexplained infertility.Methods:We prospectively recruited 83 women undergoing myomectomy for unexplained infertility with intramural myomas between June 2008 and November 2012 and classified them into non-CDMs group (n = 45) and CDMs group (n = 38). We then compared postoperative infertility rates, spontaneous pregnancy rates, pregnancy outcomes, live birth rates, and obstetric complications. For continuous variables, we calculated the mean ± standard deviation, median and interquartile range, and analyzed the data using Student's t-test and the Mann-Whitney U-test. For categorical variables, the Pearson's Chi-square test, the continuity correction test, and Fisher's exact test were used.Results:Patients’ demographics and myoma characteristics were comparable between the two groups. The overall spontaneous pregnancy rate increased from 0% to 68.42% following myomectomy. The postoperative infertility rate was significantly higher in the non-CDMs group than that in the CDMs group (50.00% vs. 23.53%, t = 5.579, P = 0.018), whereas the postoperative spontaneous pregnancy rate was significantly lower in the non-CDMs group than that in the CDMs group (47.62% vs. 70.59%, t = 4.067, P = 0.044). Compared with the enucleation of non-CDM, the enucleation of CDM patients was a protective factor for the fertility restoration (risk ratio [RR] = 3.717, 95% confidence interval [CI]: 1.284–10.753, P = 0.015), although postoperative fertility restoration declined with age (RR = 1.141, 95% CI: 1.005–1.295, P = 0.041).Conclusions:Intramural myomas are associated with impaired fertility. Women experiencing unexplained infertility, and possessing intramural myomas, have a better chance of conception following myomectomy, and these benefits are more obvious for younger patients and patients with CDM.

show abstract

Section: Introductionmentioning

confidence: 99%

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Tian

Wang

et al. 2017

Chinese Medical Journal

View full text Add to dashboard Cite

show abstract

“…Myomectomy is the most common conservative treatment in gynecology, performed by classical open surgery or by laparoscopy. 4 There is support for performing myomectomy by removing the fibroid from its surrounding structure, the fibroid pseudocapsule, 5 an “intracapsular myomectomy.” It is performed by stretching and extracting fibroid tissue directly from the surrounding fibromuscular skeleton, breaking up the fibrous bridges. The importance of intracapsular myomectomy was described in a recent review.…”

Section: Introductionmentioning

confidence: 99%

Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

Tinelli

Malvasi

Hurst

et al. 2012

JSLS

View full text Add to dashboard Cite

show abstract

“…1 Myoma is mostly asymptomatic. Size and location are the main factors that determine if a myoma leads to symptoms and problems.…”

Section: Introductionmentioning

confidence: 99%

A comparative study between the efficacy of local intra-myometrial injection of vasopressin and octreotide acetate, in reducing blood loss during myomectomy

Badawy

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

Background: Symptomatic Uterine leiomyomata may lead to many symptoms including abnormal uterine bleeding, mass pressure effects and infertility. Myomectomy is an option for conservative management, however, it is associated with some disadvantages, mainly increased intra-operative blood loss. Intra-myometrial vasopressin injection during myomectomy is an effective method to decrease the intraoperative bleeding due to its vasoconstrictor effect. Octreotide Acetate (OA) is another vasoconstrictor agent that have not been tested for gynaecologic indications. The current study was conducted to assess the efficacy of local injection of OA in reducing blood loss during conventional abdominal myomectomy, and to compare it with local instillation of vasopressin.Methods: 60 cases with symptomatic leiomyomata were recruited and planned for abdominal myomectomy, they were divided randomly into 3 groups, 20 cases in each. Group I, where local vasopressin was used, group II, where OA was used, and group III (the control group), where no specific medication was used and only free Saline was injected locally.Results: The overall results showed that OA group had significantly less operative time and less blood loss compared to control group. However, when compared to cases in group I, operative time and blood loss were significantly higher. Postoperative haemoglobin levels were significantly lower in group III compared to groups I (P = 0.039) and II (P = 0.044). Blood transfusion was indicated in 9 cases among group III, while only one case needed blood transfusion in group II, and no cases in group I.Conclusions: The use of local intra-myometrial OA is an option for reducing blood loss during myomectomy, but still efficacy is less than local vasopressin. This may be attributed to the low concentrations used, and to the less potency of OA as a vasoconstrictor agent.

show abstract

The role of laparoscopic myomectomy in the management of uterine fibroids

Cited by 51 publications

References 24 publications

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women

Surgical Management of Neurovascular Bundle in Uterine Fibroid Pseudocapsule

A comparative study between the efficacy of local intra-myometrial injection of vasopressin and octreotide acetate, in reducing blood loss during myomectomy

Contact Info

Product

Resources

About