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Gynecological Surgery 2017Increased awareness of leiomyosarcoma (LMS) risk during myomectomy or hysterectomy is essential. Objective and correct reasoning should prevail on any decision regarding...
BACKGROUND
Increased awareness of leiomyosarcoma (LMS) risk during myomectomy or hysterectomy is essential. Objective and correct reasoning should prevail on any decision regarding the extent and type of surgery to employ. The anticipated risk of a sarcoma after myoma or uterus morcellation is low, and the frequency of leiomyosarcoma especially in women below the age of 40 is very rare. The prevalence data has a wide range and is therefore not reliable. The European Society of Gynaecological Endoscopy (ESGE) initiated a survey among its members looking into the frequency of morcellated leiomyosarcoma after endoscopic surgery.The ESGE Central office sent 3422 members a structured electronic questionnaire with multiple answer choices for each question. After 3 months, the answers were classified with a unique number in the EXCEL spread sheet. Statistical analysis was done using the SPSS v.18.
RESULTS
Out of 3422 members, 294 (8.6%) gynaecologists replied to the questionnaire; however, only 240 perform myomectomies by laparoscopy and hysteroscopy and hysterectomies by laparoscopy. The reported experience in performing laparoscopic myomectomy, hysteroscopic myomectomy, laparoscopic hysterectomy (LH), and laparoscopic subtotal hysterectomy (LSH) on an average was 10.8 (1-32) years. The vast majority of 67.1% had over 5 years of practice in laparoscopic surgery. The total number of 221 leiomyosarcoma was reported among 429,777 minimally invasive surgeries (laparoscopic and hysteroscopic myomectomies and LH and LSH), performed by all doctors in their lifetime. The overall reported sarcoma risk of all types of endoscopic myoma surgeries has been estimated to be 1.5% of operations which is very rare. Categorizing by type, 57 (0.06%) LMS were operated by laparoscopic myomectomy and 54 (0.07%) by hysteroscopic myomectomy, while 38 (0.13%) leiomyosarcoma operated by laparoscopic subtotal hysterectomy and 72 (0.31%) by laparoscopic hysterectomy. The probability of a sarcoma after morcellation to be falsely diagnosed by histopathology as a benign tumour and later identified as a sarcoma in a later examination has been reported and calculated to be 0.2%. The low risk of a sarcoma is also reflected by the small number of surgeries, where only 32 doctors reported that they operated once, 29 twice, and 18 operated on 3-10 sarcomas by laparoscopy during their lifetime.
CONCLUSION
The survey demonstrated that myomectomy by hysteroscopy or laparoscopy has similar risks of sarcoma with an estimated incidence of 0.07%, much lower than that by laparoscopic hysterectomy and subtotal hysterectomy. Hence, for young patients with myoma infertility problem and low risk for LMS, myomectomy by MIS can be the first option of treatment. The fact that only 12.5% (216/1728) of uterine sarcoma cases are operated laparoscopically demonstrates the surgeons' awareness and alertness about LMS and the potential of spreading sarcomatous cells after myoma/uterus power morcellation.
PubMed: 29238287
DOI: 10.1186/s10397-017-1027-z -
Journal of the Formosan Medical... Nov 2022To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M).
PURPOSE
To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M).
METHODS
The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed.
RESULTS
The age of the participants was 39.3 ± 6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5 ± 2.2 cm and 1.7 ± 1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5 cm in diameter. The mean weight of the myomas was 281.1 ± 183.1 g. The operation time was 97.6 ± 40.2 min, and the intraoperative blood loss was 99.3 ± 115.2 mL. There were 3 (1%) cases of excessive blood loss (more than 500 mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3 ± 32.2 min vs. 141.2 ± 54 min, p < .001), while the myoma number, myoma diameter, myoma weight, and intraoperative blood loss were not significantly different. The operation time did not differ among different myoma locations. In multivariate analysis, virginity, myoma number, more than 2 large myomas, and myoma size were independent variables for longer operation times. No patient experienced any major complications.
CONCLUSION
LETS-M using conventional laparoscopic equipment is a minimally invasive surgical method that is safe, effective, and easy to learn for managing uterine myoma. It is useful to achieve a favorable perioperative outcome with acceptable operation time.
Topics: Adult; Blood Loss, Surgical; Enkephalin, Leucine; Female; Humans; Laparoscopy; Middle Aged; Myoma; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms
PubMed: 35570051
DOI: 10.1016/j.jfma.2022.04.013 -
Obstetrics & Gynecology Science Mar 2015To determine if neurofilament (NF) is expressed in the endometrium and the lesions of myomas and adenomyosis, and to determine their correlation.
OBJECTIVE
To determine if neurofilament (NF) is expressed in the endometrium and the lesions of myomas and adenomyosis, and to determine their correlation.
METHODS
Histologic sections were prepared from hysterectomies performed on women with adenomyosis (n=21), uterine myoma (n=31), and carcinoma in situ of the uterine cervix. Full-thickness uterine paraffin blocks, which included the endometrium and myometrium histologic sections, were stained immunohistochemically using the antibodies for monoclonal mouse antihuman NF protein.
RESULTS
NF-positive cells were found in the endometrium and myometrium in 11 women with myoma and in 7 with adenomyosis, but not in patients with carcinoma in situ of uterine cervix, although the difference was statistically not significant. There was no significant difference between the existence of NF-positive cells and menstrual pain or phases. The NF-positive nerve fibers were in direct contact with the lesions in nine cases (29.0%) of myoma and in five cases (23.8%) of adenomyosis. It was analyzed if there was a statistical significance between the existence of NF positive cells in the endometrium and the expression of NF-positive cells in the uterine myoma/adenomyosis lesions. When NF-positive cell were detected in the myoma lesions, the incidence of NF-positive nerve cells in the eutopic endometrium was significantly high. When NF-positive cell were detected in the basal layer, the incidence of NF-positive nerve cells in the myoma lesions and adenomyosis lesions was significantly high.
CONCLUSION
We assume that NF-positive cells in the endometrium and the myoma and adenomyosis lesions might play a role in pathogenesis. Therefore, more studies may be needed on the mechanisms of nerve fiber growth in estrogen-dependent diseases.
PubMed: 25798429
DOI: 10.5468/ogs.2015.58.2.150 -
BioMed Research International 2018Myomas, also known as fibroids, are a specific characteristic of the human species. No other primates develop fibroids. At a cellular level, myomas are benign... (Review)
Review
Myomas, also known as fibroids, are a specific characteristic of the human species. No other primates develop fibroids. At a cellular level, myomas are benign hyperplastic lesions of uterine smooth muscle cells. There are interesting theoretical concepts that link the development of myomas in humans with the highly specific process of childbirth from an upright position and the resulting need for greatly increased "expulsive" forces during labor. Myomas might be the price our species pays for our bipedal and highly intelligent existence. Myomas affect, with some variability, all ethnic groups and approximately 50% of all women during their lifetime. While some remain asymptomatic, myomas can cause significant and sometimes life-threatening uterine bleeding, pain, infertility, and, in extreme cases, ureteral obstruction and death. Traditionally, over 50% of all hysterectomies were performed for fibroids, leading to a significant healthcare burden. In this article, we review the developments of the past 20 years with regard to multiple new treatment strategies that have evolved during this time.
Topics: Female; Humans; Leiomyoma; Uterine Neoplasms
PubMed: 29789793
DOI: 10.1155/2018/4593875 -
The Pan African Medical Journal 2022Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma... (Review)
Review
Uterine artery embolization (UAE) is a very efficient treatment modality for myoma. A rare complication of this procedure is vaginal expulsion of the uterine myoma (expelled myoma) which may occur in 3 to 5% of cases during a period of 3 to 48 months. We report a case of myoma expulsion after embolization, discussing diagnosis and treatment. A literature review was also conducted. A 40-year-old patient sought medical care on 5/2/2021 with intermittent pelvic pain and hypermenorrhagia. Vaginal ultrasound revealed an enlarged uterus (253 cm) with myomas. The largest intramural myoma measured 7 cm. Uterine artery embolization was performed on 11/11/2021, without any complications. On 12/7/2021, during clinical examination an expelled myoma was observed entirely inside the vaginal canal. A vaginal myomectomy was performed, without any complications. At 15 months after the initial follow-up, the patient is doing well.
Topics: Female; Humans; Adult; Uterine Neoplasms; Embolization, Therapeutic; Leiomyoma; Myoma; Uterus; Uterine Artery Embolization
PubMed: 36942141
DOI: 10.11604/pamj.2022.43.210.38030 -
Obstetrics & Gynecology Science Jan 2019To evaluate the feasibility of robotic single-site myomectomy (RSSM).
OBJECTIVE
To evaluate the feasibility of robotic single-site myomectomy (RSSM).
METHODS
Medical records of 355 consecutive women who underwent robotic-assisted laparoscopic myomectomy were retrospectively reviewed. Clinical characteristics were compared between multi-site and single-site systems. After 1:1 propensity score matching for the total myoma number, largest myoma size, and total tumor weight (105 women in each group), surgical outcomes were also compared between the 2 systems.
RESULTS
A total of 105 (29.6%) and 250 (70.4%) women underwent RSSM and robotic multi-site myomectomy (RMSM), respectively. RSSM was more commonly performed in women with lower body mass index (21.6 vs. 22.5 kg/m, =0.014), without peritoneal adhesions (7.6% vs. 24.8%, <0.001), and less (2.6 vs. 4.6, <0.001) and smaller (6.3 vs. 7.7 cm, <0.001) myomas compared to RMSM. After propensity score matching, the largest myoma size (=0.143), total myoma number (=0.671), and tumor weight (=0.510) were not significantly different between the 2 groups. Although the docking time was significantly longer in the RSSM group (5.1 vs. 3.8 minutes, =0.005), total operation time was similar between RSSM and RMSM groups (145.9 vs. 147.3 minutes, =0.856). Additionally, hemoglobin decrement was lower in the RSSM group than in the RMSM group (1.4 vs. 1.8 g/dL, =0.009). No surgical complication was observed after RSSM, while 1 ileus and 2 febrile complications occurred in women that underwent RMSM (0% vs. 2.9%, =0.246).
CONCLUSION
Although RMSM is preferred for women with multiple large myomas in real clinical practice, RSSM seems to be a feasible surgical method for less complicated cases, and is associated with minimal surgical morbidity.
PubMed: 30671394
DOI: 10.5468/ogs.2019.62.1.56 -
Przeglad Menopauzalny = Menopause Review Dec 2016Uterine myomas (fibromas, leiomyomas) are the most common tumours in women, and their clinical signs and symptoms are presented by 25-40% of patients with these benign... (Review)
Review
Uterine myomas (fibromas, leiomyomas) are the most common tumours in women, and their clinical signs and symptoms are presented by 25-40% of patients with these benign tumours. According to current guidelines, the armamentarium for myoma management consists of: medical therapy (GnRH, SPRMs), non-surgical alternatives including uterine artery embolisation (UAE), vaginal temporary occlusion of uterine arteries using clamp-like device or MRgFUS technique, and surgical treatment (including minimally invasive techniques). In cases of submucous myomas STEPW classification correlates very well with the risk of incomplete hysteroscopic myomectomies. According to limited literature data, ulipristal acetate as a pre-treatment seems to be very prudent in high complexity hysteroscopic myomectomy (STEPW II, score 5-6). In patients with large uterine myomas (FIGO type 3, 4, 5) undergoing laparoscopic myomectomy, three-month pre-treatment with ulipristal acetate before laparoscopy is feasible and can be recommended because of shorter time of surgery, lower intraoperative blood loss, lower haemoglobin drop, and low postoperative blood transfusion rate.
PubMed: 28250723
DOI: 10.5114/pm.2016.65664 -
BMC Pediatrics Jun 2023To investigate the complete clinical spectrum of individuals with paediatric tuberous sclerosis complex in southern Sweden and explore changes over time. (Observational Study)
Observational Study
AIM
To investigate the complete clinical spectrum of individuals with paediatric tuberous sclerosis complex in southern Sweden and explore changes over time.
METHODS
In this retrospective observational study, 52 individuals aged up to 18 years at the study start were followed-up at regional hospitals and centres for habilitation from 2000 to 2020.
RESULTS
Cardiac rhabdomyoma was detected prenatally/neonatally in 69.2% of the subjects born during the latest ten years of the study period. Epilepsy was diagnosed in 82.7% of subjects, and 10 (19%) were treated with everolimus, mainly (80%) for a neurological indication. Renal cysts were detected in 53%, angiomyolipomas in 47%, astrocytic hamartomas in 28% of the individuals. There was a paucity of standardized follow-up of cardiac, renal, and ophthalmological manifestations and no structured transition to adult care.
CONCLUSION
Our in-depth analysis shows a clear shift towards an earlier diagnosis of tuberous sclerosis complex in the latter part of the study period, where more than 60% of cases showed evidence of this condition already in utero due to the presence of a cardiac rhabdomyoma. This allows for preventive treatment of epilepsy with vigabatrin and early intervention with everolimus for potential mitigation of other symptoms of tuberous sclerosis complex.
Topics: Adult; Child; Humans; Aged; Tuberous Sclerosis; Everolimus; Rhabdomyoma; Sweden; Early Intervention, Educational; Heart Neoplasms
PubMed: 37386496
DOI: 10.1186/s12887-023-04137-4 -
Journal of Minimally Invasive Gynecology Nov 2023Although it is assumed that myomectomy improves uterine myoma-related symptoms such as pelvic pain and heavy menstrual bleeding (HMB), validated measures are rarely...
STUDY OBJECTIVE
Although it is assumed that myomectomy improves uterine myoma-related symptoms such as pelvic pain and heavy menstrual bleeding (HMB), validated measures are rarely reported. This study aimed to verify the effect of myomectomy on myoma-related symptoms.
DESIGN
A retrospective cohort study.
SETTING
A university-affiliated hospital.
PATIENTS
Our study included 241 patients with a myoma diagnosis and received a myomectomy between 2004 and 2018. Data were collected from the patient medical file and patients responded in 1 questionnaire.
INTERVENTIONS
Transcervical resection of myoma (TCRM) and laparoscopic or abdominal myomectomy (LAM).
MEASUREMENTS AND MAIN RESULTS
One year after TCRM, a significant number of women experienced symptom improvement for pelvic pain (79% [19/24, p = .01]) and HMB (89% [46/52, p <.001]). For other myoma-related symptoms, abdominal pressure (43%, 10/23), sexual complaints (67%, 2/3), infertility (56%, 10/18), and other complaints (83%, 5/6), improvements were not statistically significant. One year after LAM, a significant number of women experienced symptom improvement for pelvic pain (80%, 74/93), HMB (83%, 94/113), abdominal pressure (85%, 79/93), sexual complaints (77%, 36/47), and other complaints (91%, 40/44). One year after myomectomy, 47% (30/64) (TCRM) and 44% of women (78/177) (LAM) described no myoma-related symptoms. Most women (82% [172/217]) were satisfied with the postoperative result after 1 year and 53% (114/217) would have liked to receive the myomectomy earlier in life. Average quality of life (measured on a 10-point Likert scale) increased from 6.3 at baseline to 8.0 at 1 year after TCRM and from 6.2 to 8.0 1 year after LAM, resulting in a difference of 1.7 points (p <.001; 95% confidence interval, 1.1-2.3) and 1.9 points (p <.001; 95% confidence interval, 1.4-2.3), respectively.
CONCLUSION
One year after myomectomy, most women have benefited from myomectomy, concluded by a significant number of women who experienced myoma-related symptom improvement, positive patient satisfaction, and a significant improvement in reported quality of life. Validation of results after conventional treatment such as myomectomy is essential in counseling patients for surgical treatment in today's evidence based practice. In addition, it is necessary to make an adequate comparison with new treatment options for myomas. To provide this, further research should preferably be conducted prospectively or by randomization.
Topics: Female; Humans; Uterine Myomectomy; Uterine Neoplasms; Retrospective Studies; Quality of Life; Myoma; Pelvic Pain; Laparoscopy
PubMed: 37453499
DOI: 10.1016/j.jmig.2023.07.001 -
Obstetrics & Gynecology Science Sep 2014To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm.
OBJECTIVE
To evaluate the safety of cesarean myomectomy in large myomas sized >5 cm.
METHODS
One hundred sixty-five pregnant women with myomas who delivered via cesarean section were identified. Ninety-six women had cesarean section without myomectomy, and 65 women underwent cesarean myomectomy. We compared the maternal characteristics, neonatal weight, myoma types, and operative outcomes between two groups. We further analyzed cesarean myomectomy group according to myoma size. The large myoma was defined as myoma >5 cm in size. The maternal characteristics, neonatal weight, and myoma types were compared between two groups. We also compared the operative outcomes such as preoperative and postoperative hemoglobin, operative time, and hospitalized days between two groups.
RESULTS
There were no significant differences in the maternal characteristics, myoma types, neonatal weight and operative outcomes between cesarean section without myomectomy and cesarean myomectomy. The subgroup analysis according to myoma size (>5 cm or not) in cesarean myomectomy group revealed that there were no significant differences in the mean hemoglobin change (1.2 vs. 1.3 mg/dL, P=0.6), operative time (90.5 vs. 93.1 minutes, P=0.46), and the length of hospital stay (4.7 vs. 5.2 days, P=0.15) between two groups. The comparison of maternal characteristics, neonatal weight, and myoma types between two groups also showed no statistical significance.
CONCLUSION
Cesarean myomectomy in patients with large myomas is a safe and effective procedure.
PubMed: 25264526
DOI: 10.5468/ogs.2014.57.5.367