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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transient occlusion of uterine arteries with endoscopic vascular clip preceding laparoscopic myomectomy.J Laparoendosc Adv Surg Tech. 2013; 23: 679-683https://doi.org/10.1089/lap.2012.0540
- Fibroids (uterine myomatosis, leiomyomas).Clin Evid (Online). 2002; : 1666-1678
- Uterine myomas: An overview of development, clinical features, and management.Obstet Gynecol. 2004; 104: 393-406https://doi.org/10.1097/01.AOG.0000136079.62513.39
- Fibroids and infertility: an updated systematic review of the evidence.Fertil Steril. 2009; 91: 1215-1223https://doi.org/10.1016/j.fertnstert.2008.01.051
- Leiomyomas in pregnancy and spontaneous abortion: A systematic review and meta-analysis.Obstet Gynecol. 2017; 130: 1065-1072https://doi.org/10.1097/AOG.0000000000002313
- Fibroids, infertility and pregnancy wastage.Hum Reprod Update. 2000; 6: 614-620https://doi.org/10.1093/humupd/6.6.614
- Uterine leiomyomata: Etiology, symptomatology, and management.Fertil Steril. 1981; 36: 433-445https://doi.org/10.1016/S0015-0282(16)45789-4
- Uterine fibroids.N Engl J Med. 2015; 372: 1646-1655https://doi.org/10.1056/NEJMcp1411029
- Prevention and Management of Complications in Laparoscopic Myomectomy.Biomed Res Int. 2018; 2018: 1-9https://doi.org/10.1155/2018/8250952
- Radiographic imaging techniques for the diagnosis of abnormal uterine bleeding.Obstet Gynecol Clin North Am. 2000; 27: 245-276https://doi.org/10.1016/S0889-8545(00)80019-4
- The effect of pelvic MR imaging on the diagnosis and treatment of women with presumed symptomatic uterine fibroids.J Vasc Interv Radiol. 2002; 13: 1149-1153https://doi.org/10.1016/S1051-0443(07)61957-5
- Laparoscopic myomectomy and abdominal myomectomy.Clin Obstet Gynecol. 2006; 49: 789-797https://doi.org/10.1097/01.grf.0000211949.36465.ef
- Modern management of uterine fibroids.Acta Obstet Gynecol Scand. 2008; 87: 812-823https://doi.org/10.1080/00016340802146912
- Surgical treatment of fibroids for subfertility.Cochrane Database Syst Rev. 2020; 2020https://doi.org/10.1002/14651858.CD003857.pub4
- The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature.Arch Gynecol Obstet. 2015; 291: 737-743https://doi.org/10.1007/s00404-014-3546-4
- Laparoscopic Myomectomy with Temporary Bilateral Uterine Artery and Utero-Ovarian Vessels Occlusion Compared with Traditional Surgery for Uterine Fibroids: Blood Loss and Recurrence.Gynecol Obstet Invest. 2019; 84: 548-554https://doi.org/10.1159/000499494
Anderson JK. Commentary on Laboratory evaluation of laparoscopic vascular clamps using a load-cell device-are all clamps the same?. Lee HJ, Box GN, Abraham JB, Elchico ER, Panah RA, Taylor MB, Moskowitz R, Deane LA, McDougall EM, Clayman RV, Department of Urology, Uni. Urol Oncol Semin Orig Investig 2009;27:346–7. Doi: 10.1016/j.urolonc.2009.02.010.
- Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: A systematic review and meta-analysis.Gynecol Oncol. 2015; 137: 167-172https://doi.org/10.1016/j.ygyno.2014.11.011
- Laparoscopic myomectomy: A current view.Hum Reprod Update. 2000; 6: 588-594https://doi.org/10.1093/humupd/6.6.588
- Laparoscopic versus open myomectomy-A meta-analysis of randomized controlled trials.Eur J Obstet Gynecol Reprod Biol. 2009; 145: 14-21https://doi.org/10.1016/j.ejogrb.2009.03.009
- Techniques of laparoscopic myomectomy.Reprod Biomed Online. 2011; 23: 34-39https://doi.org/10.1016/j.rbmo.2010.09.011
- Minimally invasive surgical techniques vs open myomectomy for treatment of uterine fibroids.World J Laparosc Surg. 2016; 9: 126-129https://doi.org/10.5005/jp-journals-1000710.5005/jp-journals-10033-1289
Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2014; 2014. Doi: 10.1002/14651858.CD005355.pub5.
- Fertility and pregnancy outcomes after uterine artery occlusion with or without myomectomy.Taiwan J Obstet Gynecol. 2012; 51: 331-335https://doi.org/10.1016/j.tjog.2012.07.002
- Laparoscopic transient uterine artery occlusion and myomectomy for symptomatic uterine myoma.Fertil Steril. 2011; 95: 254-258https://doi.org/10.1016/j.fertnstert.2010.05.006
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.
Article info
Publication history
Published online: August 25, 2021
Accepted:
August 23,
2021
Received in revised form:
August 11,
2021
Received:
May 9,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
