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Journal of Robotic Surgery Aug 2023The objective of this study was to compare the surgical outcomes of robotic multi-site myomectomy (RMSM) with those of robotic single-site myomectomy (RSSM). We... (Meta-Analysis)
Meta-Analysis Review
The objective of this study was to compare the surgical outcomes of robotic multi-site myomectomy (RMSM) with those of robotic single-site myomectomy (RSSM). We conducted a systematic search of the PubMed, CINAHL, Scopus, and Google Scholar databases for articles comparing RMSM and RSSM until March 2023. Data analysis was performed using Review Manager V5.3 (Cochrane), and the main outcomes examined were perioperative outcomes and complications. A total of five studies, covering 823 patients, were included in the analysis. The statistical analysis revealed no significant differences between RMSM and RSSM with regard to docking time (p = 0.9), console time (p = 0.37), estimated blood loss (p = 0.38), postoperative hemoglobin (Hb) loss (p = 0.61), transfusion rate (p = 0.25), length of stay (p = 0.08), conversion (p = 0.36), postoperative fever (p = 0.46), intraoperative complication (p = 0.23), or postoperative complication (p = 0.12). However, compared to RMSM, RSSM was found to have a shorter morcellation time (weighted mean difference [WMD] - 4.52 min; 95% confidence interval [CI] - 6.89 to 2.15; p = 0.0002), less total operative time (WMD - 9.83 min; 95% CI - 18.27 to - 1.38; p = 0.02), lower Hb change (WMD - 0.28 g/dL; 95% CI - 0.49 to - 0.07; p = 0.008), and fewer overall complications (odds ratio [OR] 0.55; 95% CI 0.32-0.92; p = 0.02). Our findings suggest that RSSM is a safe and effective alternative to RMSM for the most studied outcomes. Further randomized studies are necessary to validate these results.
Topics: Female; Humans; Uterine Myomectomy; Robotic Surgical Procedures; Intraoperative Complications; Postoperative Complications; Operative Time; Laparoscopy; Treatment Outcome
PubMed: 37093509
DOI: 10.1007/s11701-023-01597-9 -
Obstetrics and Gynecology Jun 2024To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal.
OBJECTIVE
To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal.
DATA SOURCES
Online searches: MEDLINE, ClinicalTrials.gov, PubMed, Cochrane Library, and PROSPERO Library from 1994 to 2023.
METHODS OF STUDY SELECTION
A total of 5,143 studies were identified, with inclusion of 13 study groups.
TABULATION, INTEGRATION AND RESULTS
Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates and ongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of less than 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinical pregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38-0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41-0.86). The ORs for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29-0.63) and, for ongoing pregnancy or live-birth rates, an OR at 0.38 (95% CI, 0.24-0.59). In data sets without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of 0.75 (95% CI, 0.58-0.96). Women with leiomyomas larger than 5 cm showed no differences in clinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI, 0.32-1.58). Although women with a single leiomyoma in any location had no differences in outcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing pregnancy or live-birth rates, with an OR of 0.62 (95% CI, 0.44-0.86) and 0.57 (95% CI, 0.36-0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramural leiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10 (95% CI, 0.77-1.59).
CONCLUSION
Even small intramural leiomyomas are associated with lower fertility; removal does not confer benefit. Women with more than one leiomyoma in any location have reduced fertility.
PubMed: 38935974
DOI: 10.1097/AOG.0000000000005661 -
British Journal of Neurosurgery Dec 2023The purpose of this study is to systematically review the literature on the clinical outcomes following different surgical techniques in patients with refractory... (Review)
Review
OBJECTIVE
The purpose of this study is to systematically review the literature on the clinical outcomes following different surgical techniques in patients with refractory idiopathic intracranial hypertension (IIH).
BACKGROUND
IIH is a condition characterised by increased cranial pressure (ICP) in the absence of an intracranial lesion that does not adequately respond to different medical and surgical therapies. Cranial decompression or expansion surgeries are a last resort therapy for patients with refractory IIH.
METHODS
A systematic literature search of the databases of PubMed, Embase and Medline from inception to 2019 was performed. Searches were limited to the English language and to clinical studies. Studies were included if clinical outcomes following different cranial decompression or expansion techniques were reported. We also add one case of our own experience with performing a bilateral frontoparietal expansion craniotomy and subtemporal craniectomy.
RESULTS
Five manuscripts, describing 38 procedures, met the inclusion criteria. Thirty-one patients were female (82%). The mean age was 26.2 years. The techniques studied included subtemporal craniectomy (27/38, 71%), internal cranial expansion (10/38, 26%), and cranial morcellation decompression (1/38, 3%). Thirty-five patients presented with headaches of which 17 noted postoperative improvement or resolution (49%). Visual deficits were documented in 30 patients and 25 reported postoperative improvement (83%). Papilledema disappeared in 23 of 32 patients with this sign at presentation (72%). In our patient, symptoms completely resolved postoperatively and a 6% increase in intracranial volume was measured.
CONCLUSIONS
Cranial vault decompression or expansion surgeries may be an effective last resort therapy for patients with refractory IIH. These surgeries expand the intracranial volume, and thus may normalise ICP, leading to clinical improvement.
Topics: Humans; Female; Adult; Male; Pseudotumor Cerebri; Skull; Papilledema; Craniotomy; Decompression; Intracranial Hypertension
PubMed: 34969345
DOI: 10.1080/02688697.2021.2022097 -
International Journal of Gynaecology... Mar 2024To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature. (Review)
Review
OBJECTIVE
To describe a case of extrauterine adenomyoma (EA) and review all the cases of EA in the literature.
METHODS
Pubmed/MEDLINE, Embase, and Google Scholar from 1807 to December 2022. All studies reporting the histologic diagnosis of an EA. We collected the following data: patient's age, size and location of adenomyoma, presence of endometriosis and adenomyosis, past gynecologic treatment, symptoms, diagnostic imaging, surgical intervention, alternative/adjuvant treatment, associated malignancy, and follow up.
RESULTS
Sixty-seven studies with 85 patients were included. Pain was the most frequent symptom (69.5%). Among diagnostic examinations, ultrasonography was used in 60 out of 81 reported cases, with several radiologic features described. EA was located inside the pelvis in 77.6% of patients. Adnexa were the most frequent site of the disease (24, 28.2%). History of endometriosis or adenomyosis was described in 35 patients (35, 41.2%). Uterine tissue morcellation was reported in 6 of the 85 patients (7.1%). Associated malignancy was detected in 9 out of 85 patients with available data (10.6%). There were two recurrences of disease.
CONCLUSION
Specific imaging features of EA are yet to be described in the literature. History of endometriosis and adenomyosis or uterine tissue morcellation may be suggestive of EA. Histologic examination can give a definitive diagnosis and exclude malignant transformation.
Topics: Humans; Female; Endometriosis; Adenomyosis; Adenomyoma; Uterus; Pelvis; Uterine Neoplasms
PubMed: 37688388
DOI: 10.1002/ijgo.15049 -
Journal of Robotic Surgery Mar 2024The article "Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases" by Kim et al....
The article "Comparison of operative and fertility outcomes of single-incision robotic myomectomy: a retrospective single-center analysis of 286 cases" by Kim et al. compares the effectiveness of robotic single-port myomectomy against the traditional multiport approach. The study finds similar operating outcomes, complication rates, and pregnancy rates in expert hands for both methods. Our systematic review supports these findings, revealing no significant differences in operative time, blood loss, or complication rates. Recent meta-analysis further emphasizes the benefits of the single-port approach in reducing morcellation time, overall operative duration, and blood loss. Our letter seeks insights on patient selection criteria to minimize conversion rates between surgical approaches and inquiries on learning curve differences. Additionally, we seek cost analysis details for both techniques. We appreciate the authors' valuable contributions to this field.
Topics: Female; Humans; Uterine Myomectomy; Robotic Surgical Procedures; Patient Selection; Retrospective Studies; Learning Curve; Laparoscopy; Operative Time; Surgical Wound
PubMed: 38492079
DOI: 10.1007/s11701-024-01903-z