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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 and Gynecology International 2013Uterine leiomyomas (fibroids or myomas) are benign tumors of uterus and clinically apparent in a large part of reproductive aged women. Clinically, they present with a... (Review)
Review
Uterine leiomyomas (fibroids or myomas) are benign tumors of uterus and clinically apparent in a large part of reproductive aged women. Clinically, they present with a variety of symptoms: excessive menstrual bleeding, dysmenorrhoea and intermenstrual bleeding, chronic pelvic pain, and pressure symptoms such as a sensation of bloatedness, increased urinary frequency, and bowel disturbance. In addition, they may compromise reproductive functions, possibly contributing to subfertility, early pregnancy loss, and later pregnancy complications. Despite the prevalence of this condition, myoma research is underfunded compared to other nonmalignant diseases. To date, several pathogenetic factors such as genetics, microRNA, steroids, growth factors, cytokines, chemokines, and extracellular matrix components have been implicated in the development and growth of leiomyoma. This paper summarizes the available literature regarding the ultimate relative knowledge on pathogenesis of uterine fibroids and their interactions with endometrium and subendometrial myometrium.
PubMed: 24163697
DOI: 10.1155/2013/173184 -
Journal of Clinical Pathology Jul 2000Extracardiac rhabdomyomas are rare benign tumours showing striated muscle differentiation. Seventy percent of these lesions occur in the head and neck region. The most...
Extracardiac rhabdomyomas are rare benign tumours showing striated muscle differentiation. Seventy percent of these lesions occur in the head and neck region. The most common sites for these lesions are the larynx, pharynx, and the floor of the mouth. There has been only one previous report of a rhabdomyoma of the oesophagus; two further cases are described.
Topics: Adult; Diagnosis, Differential; Esophageal Neoplasms; Female; Humans; Male; Rhabdomyoma
PubMed: 10961182
DOI: 10.1136/jcp.53.7.554 -
Fertility and Sterility Jan 2018To demonstrate a new approach for performing a myomectomy via transvaginal natural-orifice transluminal endoscopic surgery (vNOTES) as an alternative to laparoscopic...
OBJECTIVE
To demonstrate a new approach for performing a myomectomy via transvaginal natural-orifice transluminal endoscopic surgery (vNOTES) as an alternative to laparoscopic myomectomy.
DESIGN
Stepwise explanation of the technique with the use of original video footage.
SETTING
Hospital.
PATIENT(S)
Eight patients were treated transvaginally for intramural, subserosal, and pedunculated myomas.
INTERVENTION(S)
In case of a posterior myoma, a 2.5-cm posterior colpotomy was made under general anesthesia. The pouch of Douglas was opened and a vNOTES port was inserted transvaginally. In case of an anterior myoma, an anterior colpotomy was made and the peritoneum was opened between the uterus and the bladder. A vNOTES port was inserted transvaginally. A pneumoperitoneum was created and the myoma was identified. With the use of conventional endoscopic instruments and a standard endoscope, all inserted through the vNOTES port, the uterine serosa was incised over the myoma and the myoma was resected. After achieving hemostasis the uterine scar was sutured in two layers with the use of a standard absorbable suture or an autolocking suture. An adhesion-preventing barrier was applied over the uterine scar. The myoma was removed through the colpotomy in an endobag. The vNOTES port was removed and the colpotomy was sutured with the use of an absorbable suture. The following data were collected: age, body mass index, number of previous abdominal procedures, myoma size, myoma weight, operating time, length of hospital stay, visual analog scale pain score, and serum hemoglobin drop.
MAIN OUTCOME MEASURE(S)
Successful minimally invasive myomectomy via vNOTES without abdominal scars.
RESULT(S)
All fibroids were successfully removed via vNOTES without complications or conversions to standard laparoscopy. No peri- or postoperative complications occurred. All patients were discharged within 24 hours, two of them within 12 hours. Anterior myomas can be resected through an anterior colpotomy and posterior myomas can be resected through a posterior colpotomy via the pouch of Douglas. In a low-resource setting, a self-constructed gloveport can be used and the uterine scar can be sutured via vNOTES with the use of a standard absorbable suture. In a first-world setting, the surgical time can be reduced with the use of an autolocking suture and a commercially available vNOTES port.
CONCLUSION(S)
Myoma types 0-2 can be resected hysteroscopically. Myoma types 3-7 are traditionally resected via laparotomy, laparoscopy, or transabdominal robotic surgery. vNOTES provides a new less invasive approach for the resection of myoma types 3-7. This first IDEAL stage 1 study confirms the feasibility of vNOTES myomectomy. It remains, however, a novel approach that requires further investigation. It can provide better cosmetic results and improved patient comfort.
Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Length of Stay; Natural Orifice Endoscopic Surgery; Operative Time; Pain, Postoperative; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vagina
PubMed: 29129378
DOI: 10.1016/j.fertnstert.2017.09.009 -
Archives of Pathology & Laboratory... Dec 2002
Topics: Child, Preschool; Heart Neoplasms; Humans; Male; Rhabdomyoma
PubMed: 12503590
DOI: 10.5858/2002-126-999b-TMPACT -
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 -
Taiwanese Journal of Obstetrics &... Dec 2018To evaluate surgical outcomes and feasibility of robotic myomectomy in large uterine myomas.
OBJECTIVE
To evaluate surgical outcomes and feasibility of robotic myomectomy in large uterine myomas.
MATERIALS AND METHODS
This is a retrospective study for robotic myomectomies performed from October 2012 to August 2017 by a single surgeon in a tertiary care referral hospital. Demographics, diagnosis, perioperative variables, operative outcomes and complications were recorded. Large uterine myoma was defined as the estimated diameter of dominant myoma equal to or larger than 10 cm by sonography.
RESULTS
Seventy-four patients were included and 32 (43.2%) patients had large uterine myoma. Patients with myoma larger than 10 cm showed significantly heavier myoma weight (446.5 ± 206.2 mg vs. 288.1 ± 147.5, p < 0.001), similar blood loss (309.4 ± 190.3 mL vs. 200.9 ± 285.9 mL, p = 0.06), and longer operative time (263.4 ± 83.7 min vs. 219.1 ± 75.7 min, p = 0.02) compared with patients with myoma <10 cm. The largest myoma removed was 20 cm in diameter. Perioperative complications were rare.
CONCLUSION
Robotic myomectomy is feasible for managing large uterine myomas. It is a safe procedure with acceptable longer operative time.
Topics: Adolescent; Adult; Blood Loss, Surgical; Female; Humans; Leiomyoma; Middle Aged; Operative Time; Outcome Assessment, Health Care; Retrospective Studies; Robotic Surgical Procedures; Uterine Myomectomy; Uterine Neoplasms; Young Adult
PubMed: 30545529
DOI: 10.1016/j.tjog.2018.10.004 -
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 -
Fertility and Sterility Jul 1992To review, evaluate, and synthesize current published reports assessing the value of abdominal myomectomy in infertile women and those desiring to preserve fertility... (Review)
Review
OBJECTIVE
To review, evaluate, and synthesize current published reports assessing the value of abdominal myomectomy in infertile women and those desiring to preserve fertility potential.
DATA IDENTIFICATION
Major studies dealing with myomectomy were identified through Medline Searches.
STUDY SELECTION
Those papers reporting the results of myomectomy, factors influencing them, and potential future innovations were obtained.
RESULTS
More than half of women not previously pregnant and undergoing myomectomy to preserve childbearing capacity for treatment of recurrent pregnancy wastage or previous infertility conceive. The long duration of infertility before surgery, absence of other factors to explain their not conceiving, and short time interval subsequent to surgery in which conception occurs suggests myomectomy has value in treatment of patients with leiomyomata and otherwise unexplained infertility. The operation carries acceptable risk. Approximately 25% of women undergoing myomectomy have recurrent leiomyomata, but most recurrences are sufficiently delayed to allow adequate opportunity for conception.
CONCLUSIONS
Abdominal myomectomy is an appropriate alternative to hysterectomy for most women who wish to preserve childbearing potential or enhance it. For the future, myomectomy by endoscopic techniques may hold similar potential.
Topics: Female; Fertility; Humans; Infertility, Female; Myoma; Uterine Neoplasms
PubMed: 1623990
DOI: 10.1016/s0015-0282(16)55128-0 -
The Turkish Journal of Pediatrics 2023Primary cardiac tumors are extremely rare. Cardiac rhabdomyoma is the most common primary cardiac tumor. 50-80% of solitary rhabdomyomas and all multiple rhabdomyomas...
BACKGROUND
Primary cardiac tumors are extremely rare. Cardiac rhabdomyoma is the most common primary cardiac tumor. 50-80% of solitary rhabdomyomas and all multiple rhabdomyomas are associated with tuberous sclerosis complex. Due to spontaneous regression, surgery is necessary only in severe hemodynamic compromise and persistent arrhythmias. Everolimus, a mechanistic target of rapamycin (mTOR) inhibitor, can be used in the treatment of rhabdomyomas seen in tuberous sclerosis complex. We aimed to evaluate the clinical progression of rhabdomyomas followed-up in our center between the years 2014-2019 and evaluate the efficacy and safety of everolimus treatment on tumor regression.
METHODS
Clinical features, prenatal diagnosis, clinical findings, tuberous sclerosis complex presence, treatment and follow-up results were evaluated retrospectively.
RESULTS
Among 56 children with primary cardiac tumors, 47 were diagnosed as rhabdomyomas, 28/47 patients (59.6%) had prenatal diagnosis, 85.1% were diagnosed before one year of age and 42/47 patients (89.3%) were asymptomatic. Multiple rhabdomyomas were present in 51% and median diameter of tumors was 16mm (4.5 - 52 mm). In 29/47 patients (61.7%) no medical or surgical treatment were necessary while 34% of these had spontaneous regression. Surgery was necessary in 6/47 patients (12.7%). Everolimus was used in 14/47 patients (29.8%). Indications were seizures (2 patients) and cardiac dysfunction (12 patients). Regression in size of rhabdomyomas was achieved in 10/12 patients (83%). Although, in the long-term, the amount of tumor mass shrinkage was not significantly different between patients who received everolimus and untreated patients (p=0.139), the rate of mass reduction was 12.4 times higher in patients who received everolimus. Leukopenia was not detected in any of the patients, but, hyperlipidemia was noted in 3/14 patients (21.4%).
CONCLUSIONS
According to our results, everolimus accelerates tumor mass reduction, but not amount of mass regression in the long term. Everolimus may be considered for treatment of rhabdomyomas which cause hemodynamic compromise or life-threatening arrhythmias before surgical intervention.
Topics: Child; Pregnancy; Female; Humans; Adult; Everolimus; Rhabdomyoma; Tuberous Sclerosis; Retrospective Studies; Heart Neoplasms; Cardiomyopathies; Disease Progression
PubMed: 37395967
DOI: 10.24953/turkjped.2022.922