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Journal of Minimally Invasive Gynecology Feb 2023To determine the association between preoperative hematocrit level and risk of blood transfusion for laparotomic and laparoscopic myomectomy based on myoma burden and...
STUDY OBJECTIVE
To determine the association between preoperative hematocrit level and risk of blood transfusion for laparotomic and laparoscopic myomectomy based on myoma burden and surgical route.
DESIGN
A cohort study of prospectively collected data.
SETTING
American College of Surgeons National Surgical Quality Improvement Program participating institutions.
PATIENTS
A total of 26 229 women who underwent a laparotomic or laparoscopic myomectomy from 2010 to 2020.
INTERVENTIONS
The primary outcome assessed was the risk of transfusion based on preoperative hematocrit level. This was evaluated with respect to myoma burden and surgical route.
MEASUREMENTS AND MAIN RESULTS
There were 26 229 women who underwent a myomectomy during the study interval, 2345 women (9%) of whom required a blood transfusion. Compared with patients who did not require transfusion, those who did had lower median preoperative hematocrit levels (34.7 vs 38.2). Patients were stratified by surgical approach (laparotomic vs laparoscopic) and myoma burden (1-4 myomas/weight ≤250 g or ≥5 myomas/weight >250 g) using Current Procedural Terminology codes (58140, 58146, 58545, 58546). In all categories, there was an inverse relationship between blood transfusion and preoperative hematocrit level with increasing risk depending on preoperative hematocrit range. The odds ratios comparing hematocrit level of 29% with 39% were 6.16 (95% confidence interval [CI], 5.15-7.36), 4.92 (95% CI, 4.19-5.78), 4.85 (95% CI, 3.72-6.33), and 5.2 (95% CI, 3.63-7.43) for patients with laparotomic (1-4 myomas/≤250 g, ≥5 myomas/>250 g) and laparoscopic myomectomy (1-4 myomas/≤250 g, 5 myomas/>250 g), respectively.
CONCLUSION
Incremental increases in hematocrit result in a significantly decreased risk of blood transfusion at the time of myomectomy.
Topics: Humans; Female; Uterine Myomectomy; Cohort Studies; Uterine Neoplasms; Hematocrit; Myoma; Laparoscopy; Blood Transfusion
PubMed: 36332821
DOI: 10.1016/j.jmig.2022.10.010 -
European Journal of Obstetrics,... Jul 2013
Topics: Female; Humans; Mesentery; Middle Aged; Myoma; Postoperative Complications; Torsion Abnormality; Uterine Myomectomy; Uterine Neoplasms
PubMed: 23664456
DOI: 10.1016/j.ejogrb.2013.04.002 -
Fertility and Sterility Nov 2008The purpose of this Educational Bulletin is to examine the relationship between myomas and reproductive function and to review current methods for their management. (Review)
Review
The purpose of this Educational Bulletin is to examine the relationship between myomas and reproductive function and to review current methods for their management.
Topics: Antineoplastic Agents; Combined Modality Therapy; Female; Gonadotropin-Releasing Hormone; Humans; Hysteroscopy; Infertility, Female; Laparoscopy; Myoma; Neoadjuvant Therapy; Preconception Care; Pregnancy; Pregnancy Complications, Neoplastic; Reproduction; Uterine Artery Embolization; Uterine Neoplasms
PubMed: 19007608
DOI: 10.1016/j.fertnstert.2008.09.012 -
Frontiers in Bioscience (Elite Edition) Jan 2013Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for... (Review)
Review
Uterine myomas, the most common benign solid pelvic tumors in women, occur in twenty percent of them in reproductive years and form the most common indication for hysterectomy. Various factors affect the choice of the best treatment modality for a given patient. Asymptomatic myomas may be managed by careful follow up. Medical therapy should be tried as a first line of treatment for symptomatic myomas while surgical treatment should be reserved only for appropriate indications. Myomectomy would be preferred over hysterectomy in those wishing subsequent childbearing. Preoperative GnRH-analogue treatment reduces the myoma size and vascularity but may render the capsule more difficult to resect. Poor surgical risk women with large symptomatic myomas or those wishing to avoid major surgical procedures may be offered uterine artery embolization. Serial follow-up for growth and symptoms may be appropriate for asymptomatic perimenopausal women. The present article reviews the available therapeutic modalities for uterine myomas.
Topics: Antifibrinolytic Agents; Disease Management; Female; Gonadotropin-Releasing Hormone; Humans; Hysterectomy; Myoma; Norpregnadienes; Progestins; Uterine Artery Embolization; Uterine Myomectomy; Uterine Neoplasms
PubMed: 23276966
DOI: 10.2741/e592 -
Fertility and Sterility Sep 2002
Topics: Adult; Cesarean Section; Female; Humans; Infant, Newborn; Magnetic Resonance Imaging; Myoma; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Outcome; Uterine Neoplasms
PubMed: 12215346
DOI: 10.1016/s0015-0282(02)03297-1 -
Archives of Gynecology and Obstetrics Apr 2018Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5-77% of women of reproductive age. The prevalence...
OBJECTIVES
Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5-77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women.
MATERIALS/METHODS
The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study.
RESULTS
High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471).
CONCLUSIONS
It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.
Topics: Adult; Female; Fertility; Germany; Humans; Laparoscopy; Laparotomy; Leiomyoma; Morbidity; Myoma; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Prevalence; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms
PubMed: 29417281
DOI: 10.1007/s00404-018-4697-5 -
Journal of Minimally Invasive Gynecology Jun 2023To show laparoscopic management of disseminated peritoneal leiomyomatosis (DPL).
STUDY OBJECTIVE
To show laparoscopic management of disseminated peritoneal leiomyomatosis (DPL).
DESIGN
Stepwise demonstration of the technique with narrated video footage.
SETTING
DPL is characterized by dissemination and proliferation of peritoneal and subperitoneal lesions primarily originating from smooth muscle cells [1]. Generally considered benign, cases of malignant transformation to leiomyosarcoma have been reported [2,3]. Iatrogenic DPL occurs because of unconfined morcellation resulting in small fragments of myoma that may implant on any organ and start deriving blood supply from it or may be pulled into port site while withdrawing laparoscopic cannulas [4]. It is estimated that the overall incidence of DPL after laparoscopic uncontained morcellation was 0.12% to 0.95% [5]. Mainstay of treatment is surgical resection of myomas and regular follow-up with imaging. A 28-year-old unmarried girl presented with complain of lump abdomen increasing in size for 1 year. She also complained of a 15 kg weight loss in the last 1 year; 4 years ago, patient had undergone laparoscopic myomectomy with unconfined morcellation for a 10 × 8 cm cervical myoma. Presently her menses were regular with a 28-day cycle and 3 to 4 days' average flow. Magnetic resonance imaging showed multiple nodular lesions of varying sizes in relation to small bowel, colon, uterus, and anterior abdominal wall suggestive of DPL. Bilateral ovaries were normal. Tumor markers were as follows: CA 125 23.2 (<35) U/mL Carcinoembryonic antigen 1.67 (<8) ng/mL CA 19-9 47 (<37) U/mL Lactate dehydrogenase 809 (180-360) IU/L Alpha-fetoprotein 2.03 (<10) ng/mL Beta human chorionic gonadotropin 1.2(<2) mIU/mL Tru-cut biopsy was done elsewhere to rule out peritoneal carcinomatosis in view of raised CA 19-9 and lactate dehydrogenase, history of weight loss, and imaging showing multiple abdominal masses. Histopathological examination showed leiomyomatosis and immunohistochemistry for smooth muscle actin, desmin, and vimentin were positive.
INTERVENTIONS
On laparoscopy the abdominal cavity was found studded with multiple leiomyomas of varying sizes deriving blood supply from ilium, transverse, descending and sigmoid colon, rectum, left tube, left ovary, pouch of Douglas, bilateral uterosacrals, uterovesical fold, and anterior abdominal wall. Large blood vessels were seen traversing between the descending and sigmoid colon and the myomas. Principles of surgery were as follows: 1. Complete removal of myomas 2. Cauterization of blood vessels feeding the parasitic myomas to minimize blood loss 3. Disscetion abutting the myoma to prevent injury to adjacent viscera. A total of 26 myomas were removed. All the myomas were retrieved by morcellation in a bag. Histopathology confirmed the diagnosis of diffuse peritoneal leiomyomatosis. Follow-up ultrasound at 6 months showed no recurrence of leiomyomatosis.
CONCLUSION
Proper mapping of lesions and surgery for complete removal of all masses is the mainstay of treatment. Contained morcellation in bag should be the norm to prevent iatrogenic DPL. Regular follow-up with imaging is required to rule out recurrence.
Topics: Female; Humans; Adult; Leiomyomatosis; Uterine Neoplasms; Laparoscopy; Uterine Myomectomy; Myoma; Iatrogenic Disease; Lactate Dehydrogenases
PubMed: 36934877
DOI: 10.1016/j.jmig.2023.03.006 -
Fertility and Sterility Aug 2015To study the in vivo mechanisms of action of ulipristal acetate (UPA) on uterine myomas. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To study the in vivo mechanisms of action of ulipristal acetate (UPA) on uterine myomas.
DESIGN
Retrospective histologic and immunohistochemical (IHC) study of myomas.
SETTING
Academic research unit.
PATIENT(S)
Among 59 women with symptomatic myomas who underwent myomectomy, 42 were treated preoperatively with UPA, while 17 were not.
INTERVENTION(S)
Histology and IHC were analyzed on tissue microarrays obtained from surgical specimens.
MAIN OUTCOME MEASURE(S)
Proliferation, apoptosis, extracellular matrix (ECM) remodeling, and matrix metalloproteinase 2 (MMP-2) expression.
RESULT(S)
Proliferation was low in all conditions, with no statistical difference between groups. Terminal deoxynucleotide transferase-mediated dUTP nick-end labeling assay showed an increase in cell death in UPA-treated myomas compared with untreated myomas, but only after short-term treatment; this was not associated with elevated levels of cleaved caspase-3. After long-term treatment, cell density was higher and the ECM volume fraction lower in UPA-treated myomas than in untreated myomas. MMP-2 expression was found to be increased after treatment, showing the highest level after long-term treatment, compared with untreated myomas.
CONCLUSION(S)
Regarding sustained clinical volume reduction of myomas, this study strongly points to multifactorial mechanisms of action of UPA, involving: 1) a persistently low cell proliferation rate; 2) a limited period of cell death; and 3) ECM remodeling concomitant with stimulation of MMP-2 expression.
Topics: Adult; Contraceptive Agents; Double-Blind Method; Female; Humans; Leiomyoma; Middle Aged; Myoma; Norpregnadienes; Preoperative Care; Treatment Outcome; Uterine Neoplasms
PubMed: 26003270
DOI: 10.1016/j.fertnstert.2015.04.025 -
International Journal of Gynaecology... 1976A calcified myoma of the utero-ovarian ligament was encountered in a 13-year-old girl. The age of the patient and the unusual location prompt this report of a possibly...
A calcified myoma of the utero-ovarian ligament was encountered in a 13-year-old girl. The age of the patient and the unusual location prompt this report of a possibly unique entity, and the pertinent literature is cited.
Topics: Adnexa Uteri; Adolescent; Calcinosis; Female; Genital Neoplasms, Female; Humans; Myoma; Puberty
PubMed: 20366
DOI: 10.1002/j.1879-3479.1976.tb00112.x -
Journal of Minimally Invasive Gynecology Nov 2022
Topics: Female; Humans; Gynecologic Surgical Procedures; Myoma; Minimally Invasive Surgical Procedures
PubMed: 36130705
DOI: 10.1016/j.jmig.2022.09.007