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Evolution of laparoscopic myomectomy and description of two hemostatic techniques in a large teaching gynecological center

      Highlights

      • Laparoscopic myomectomy is a widespread surgical technique.
      • Hemostatic techniques allow surgeons to safely perform the surgery.
      • The temporary clipping of uterine vessels presents low intraoperative bleedings.

      Abstract

      Objective

      To provide a description of laparoscopic myomectomy and the two hemostatic techniques performed over the last 11 years in a single reference center for gynecology and obstetrics and to evaluate the factors associated with favorable surgical outcomes.

      Study Design

      We retrospectively analyzed 625 who underwent laparoscopic myomectomy from January 2009 to December 2019.

      Results

      Of 625 patients, 437 (69.8%) were symptomatic. The most common symptoms were heavy uterine bleeding (33.2%). 188 patients (30.1%) were asymptomatic but were operated in 77 cases (12.3%) for rapid fibroid growth, 32 (5.1%) for uterine cavity distortion and, in 45 cases (8.6%), the myomectomy was indicated during a surgery for other medical reason due to its accessibility. In 173 cases (27.9%) intramyometrial adrenaline was injected and in 246 cases (39.7%) a temporary blockage of the uterus blood supply was performed.
      Only 35 (5.6%) patients presented complications, of which, 14 (40%) were hemorrhagic. These hemorrhagic complications were more frequent when intramyometrial adrenaline was used (5,8%) than after the temporary clipping of the uterine arteries and infundibulopelvic ligaments (0,8%; p < 0,001).
      In the multivariate logistic regression model, the only factor statistically associated with favorable surgical outcome was the use of temporary clipping of the uterine arteries at their origin and infundibulopelvic ligaments as hemostatic technique during the surgery.

      Conclusion

      Laparoscopic myomectomy was generally safe with a high level of favorable outcomes. The temporary clipping of uterine arteries and infundibulopelvic ligaments presented fewer intraoperative bleedings compared with injecting intramyometrial adrenaline.

      Keywords

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      Biography

      Sandra Coll Girona is currently affiliated as obstetrics and gynecologic 4th year resident, Hospital Universitari Dexeus, Barcelona, Spain. Her main field of interest is Deep Endometriosis, Pelvic Floor and minimal invasive surgery.

      Biography

      Sílvia Feliu Manubens is currently affiliated as obstetrics and gynecologic 3th year resident, Hospital Universitari Dexeus, Barcelona, Spain. Main clinical interests are bening pathology, such as cervical pathology, and minimal invasive surgery, specially histeroscopy.

      Biography

      Claudia Montero Carreras is currently enrolled at the residency program, as a second year resident, on Obstetrics and Gynaecology at the Universitari Hospital of Dexeus in Barcelona, Spain. Learning and starting research on the different branches of this wide Speaciality

      Biography

      Maria Pellisé Tintoré is currently enrolled at the residency program, as a second year resident, on Obstetrics and Gynaecology at the Universitari Hospital of Dexeus in Barcelona, Spain. Learning and starting research on the different branches of this wide Speaciality.

      Biography

      Ignacio Rodríguez has MSc in Bioinformatics and Biostatistics and a graduate in statistics. He is now Head of Epidemiology Unit in the Department of Obstetrics, Gynecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain. He has authored or co-authored over 100 peer-reviewed papers

      Biography

      Francesc Treserra Casas is currently affiliated as Pathology specialist since 1994 and Head of Service since 2007 in Hospital Universitari Dexeus, Barcelona, Spain. He is specialist of Pathological Anatomy of the Hospital Mutua de Terrassa, Spain (1994), Doctor in Medicine and Surgery of the Universitat de Barcelona, Spain (2007). He has participated in 106 international publications and in 123 national publications.

      Biography

      Pere N Barri is currently the Head of Department of Obstetrics, Gynecology and Reproductive Medicine at Hospital Universitario Dexeus, Barcelona, Spain. His main field of interest is Deep Endometriosis, Pelvic Floor and Reproductive surgery. He was trained as a Gynecologic Surgeon in Spain, France and US. He has participated in many humanitary surgical trips to AfricaHe also performed an Executive Program at Harvard Business School on Management in Healthcare Delivery Dr Barri has the honor of serving at the Board of Directors of AAGL representing Europe, Middle East and Africa.