Background: Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach. Objectives: This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital. Methods: This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017. Results: There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant. Conclusions The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.
Uterine Myomectomy ; Laparoscopy

Endometriosis is the aberrant presence of endometrial tissue outside the uterine cavity. We report a case of cutaneous endometriosis which developed on the scar of a uterine myomectomy in a 35-year-old female. The patient presented with a bean-sized, oval-shaped, erythematous nodule, which was located where a drain tube had been inserted. During her first visit to our clinic, she felt slight pain upon light touch to the lesion. She was not menstruating at this time. The lesion had been getting bigger and she reported that the pain was aggravated during menstruation. Diagnosis was confirmed by histopathologic examination, which showed multiple endometrial glands with decidualized stroma, and hemosiderin pigment. Many dermatologists are not familiar with cutaneous endometriosis. Therefore, we present this case as a good example which shows pathognomonic symptoms and characteristic histopathologic findings of cutaneous endometriosis.
Adult ; Cicatrix ; Diagnosis ; Endometriosis* ; Female ; Hemosiderin ; Humans ; Menstruation ; Uterine Myomectomy

OBJECTIVETo assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.

METHODSA total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March, 2007 and March, 2012, and their post-operative complications, the need for subsequent surgery, symptomatic relief and reproductive outcomes were analyzed.

RESULTSOf these patients, 42.4% had subserosal myomas and 57.6% had intramural myomas. The mean total operative time was 96∓41 min with a mean blood loss of 128∓46.2 ml, and 82.3% of the patients were discharged 48 h after the operation without early complications. A small fraction (2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids. Of the fertility-demanding women who underwent myomectomy, 71% achieved pregnancy, 49.8% underwent caesarean section, 8% had operative vaginal deliveries, and 42.2% had spontaneous deliveries; uterine rupture occurred in none of the cases.

CONCLUSIONLaparoscopic intracapsular myomectomy, by preserving the fibroid pseudocapsule and myometrial integrity, has no early postoperative complications and ensures good fertility rates and reproductive outcomes.

Adult ; Female ; Fertility ; Humans ; Laparoscopy ; Leiomyoma ; surgery ; Prognosis ; Retrospective Studies ; Uterine Myomectomy ; Uterine Neoplasms ; surgery

Bradycardia/chemically induced* ; Female ; Humans ; Uterine Myomectomy/adverse effects* ; Uterine Neoplasms ; Vasopressins

In the reproductive age, many women have several uterine myomas and present with abnormal uterine bleeding, dysmenorrhea, and occasionally infertility. There are three surgical approaches to perform myomectomy, including robotic-assisted, laparoscopic, and abdominal myomectomy. Compared to laparoscopic procedures, robotic myomectomy allows free approach of myoma bases using fine instruments and endoscopes. Fine uterine wall sutures can be performed layer-by-layer with robots. However, robotic surgery is difficult to perform because there is no sense of touch during the operation. We report two clinical myomectomy cases with replaced lack of haptic feedback during robot surgery. The patients received robotic myomectomy with/without right ovarian cystectomy and adhesiolysis. Sixty-five leiomyomas were removed in case 1. Forty-six leiomyomas were removed in case 2. Lack of haptic feedback is replaced by more developed visual sense during robot myomectomy of multiple tiny intramural myomas, and robotic surgery can be performed much more effectively even in complicated cases.
Cystectomy ; Dysmenorrhea ; Endoscopes ; Female ; Humans ; Infertility ; Leiomyoma ; Myoma ; Robotic Surgical Procedures ; Sutures ; Uterine Hemorrhage ; Uterine Myomectomy

OBJECTIVE: This study was performed to assess our clinical experience with single-port access (SPA) laparoscopic cystectomy and myomectomy and the surgical outcomes of those procedures at our institution. METHODS: The authors evaluated the surgical outcomes of SPA laparoscopic cystectomy in 293 patients and SPA laparoscopic myomectomy in 246 patients. The surgical outcomes comprised operation time, the amount of blood loss during the operation, the change in hemoglobin (before and after the operation), the change in hematocrit (before and after the operation), switching to the multi-port access method, complications, transfusions, and the duration of the postoperative hospital stay. RESULTS: The Pearson correlation coefficient and the Spearman correlation coefficient between the operation time and the amount of blood loss were 0.312 and 0.321 for SPA laparoscopic cystectomy, respectively, and 0.706 and 0.674 for SPA laparoscopic myomectomy, respectively. The drops in hemoglobin and hematocrit were 1.33~0.78 g/dL and 4.14%~2.45%, respectively, in SPA laparoscopic cystectomy, while the corresponding figures were 1.34~1.13 g/dL and 4.17%~3.24% in SPA laparoscopic myomectomy, respectively. CONCLUSION: This study reported the surgical outcomes of SPA laparoscopic cystectomy and myomectomy and compared them to previously published findings on traditional laparoscopic cystectomy and myomectomy. No significant differences were found in the surgical outcomes between SPA and traditional laparoscopic cystectomy and myomectomy.
Cystectomy* ; Hematocrit ; Humans ; Laparoscopy ; Length of Stay ; Surgical Procedures, Minimally Invasive ; Uterine Myomectomy

We report a patient with myotonic dystrophy, who underwent a transvaginal uterine myomectomy. Anaesthesia was induced and maintained with remifentanil and the target-controlled infusion of propofol titrated according to the bispectral index (BIS). A ProSeal laryngeal mask airway (PLMA) was inserted, and mechanical ventilation was performed without a muscle relaxant. The time from the end of anaesthesia to the patient-awakening was approximately 8 minutes. The rapid offset of the action of remifentanil and low-dose propofol facilitated early recovery without respiratory complications. The total intravenous anaesthesia using the BIS and the PLMA without a muscle relaxant is a useful anaesthetic technique in myotonic dystrophy patients.
Anesthesia, Intravenous* ; Humans ; Laryngeal Masks ; Myotonic Dystrophy* ; Propofol ; Respiration, Artificial ; Uterine Myomectomy*

PURPOSE: The study was done to explore whether the duration of perioperative prophylactic antibiotics therapy influenced uncertainty of recovery in patients with elective laparoscopic uterine myomectomy. METHODS: A prospective study was conducted using self-report questionnaires and electrical medical records for patients with uterine myomectomy. According to the length of the perioperative prophylactic antibiotics therapy, the patients were divided into three groups: single-dose antibiotic treatment group, short-term antibiotic treatment group, and long-term antibiotic treatment group. Data were collected from December 20, 2016 to July 31, 2017 from 161 patients who underwent laparoscopic myomectomy at a metropolitan city general hospital. RESULTS: Level of uncertainty of recovery was 2.98±0.22. The uncertainty was highest in the long-term antibiotic treatment group, followed by the short-term antibiotic treatment group and the single-dose antibiotic treatment group (F=89.40, p < .001). In the regression analysis, factors influencing uncertainty of recovery among uterine myomectomy patients were duration of perioperative prophylactic antibiotic therapy (β=.70, p < .001) and duration of NPO (β=−.11, p=.047) which explained 51.5% of the variance (F=83.75, p < .001). CONCLUSION: Based on these results, information including the administration of antibiotics before surgery should be provided to the patients to help reduce the uncertainty of postoperative recovery.
Anti-Bacterial Agents* ; Hospitals, General ; Humans ; Medical Records ; Prospective Studies ; Uncertainty* ; Uterine Myomectomy*

BACKGROUND: Uterine myoma is the most common benign gynecologic tumor in reproductive-aged women. During myomectomy for women who want to preserve fertility, it is advisable to detect and remove all myomas to decrease the risk of additional surgery. However, finding myomas during surgery is often challenging, especially for deep-seated myomas. Therefore, three-dimensional (3D) preoperative localization of myomas can be helpful for the surgical planning for myomectomy. However, the previously reported manual 3D segmenting method takes too much time and effort for clinical use. The objective of this study was to propose a new method of rapid 3D visualization of uterine myoma using a uterine template. METHODS: Magnetic resonance images were listed according to the slide spacing on each plane of the multiplanar reconstruction, and images that were determined to be myomas were selected by simply scrolling the mouse down. By using the selected images, a 3D grid with a slide spacing interval was constructed and filled on its plane and finally registered to a uterine template. RESULTS: The location of multiple myomas in the uterus was visualized in 3D and this proposed method is over 95% faster than the existing manual-segmentation method. Not only the size and location of the myomas, but also the shortest distance between the uterine surface and the myomas, can be calculated. This technique also enables the surgeon to know the number of total, removed, and remaining myomas on the 3D image. CONCLUSION: This proposed 3D reconstruction method with a uterine template enables faster 3D visualization of myomas.
Animals ; Female ; Fertility ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Methods ; Mice ; Myoma ; Uterine Myomectomy ; Uterus

Uterine scar dehiscence following laparoscopic myomectomy rarely occurs but can compromise both maternal and fetal well-being in subsequent pregnancy. We here present two cases of pregnancy complicated by preterm birth that resulted from uterine scar dehiscence following laparoscopic myomectomy. First case was a nulligravida who had scar dehiscence at 26 weeks of gestation after having a laparoscopic myomectomy 3 months prior to conception. Two weeks later, we observed her fetal leg protruding through the defect. The other case was a primigravida with a history of prior cesarean delivery, whose sonography revealed myomectomy scar dehiscence at 31 weeks of gestation. Within a few hours after observing, the patient complained of abdominal pain that was aggravating as fetal leg protruded through the defect. In both cases, babies were born by emergency cesarean section. Conservative management can be one of treatment options for myomectomy scar dehiscence in preterm pregnancy. However, clinicians should always be aware of the possibility of obstetric emergencies.
Abdominal Pain ; Cesarean Section ; Cicatrix* ; Emergencies ; Female ; Fertilization ; Humans ; Leg ; Pregnancy* ; Premature Birth ; Uterine Myomectomy ; Uterine Rupture