Efficacy of pre‐operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review

Lethaby, Anne; Vollenhoven, Beverley; Sowter, Martin C

doi:10.1111/j.1471-0528.2002.01225.x

Cited by 188 publications

(97 citation statements)

References 23 publications

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“…Magnetic resonance imaging provides better discrimination of the source of the pelvic mass [6]. Other pre-operative measures include correction of anaemia, optimising body mass index in obese patients and anaesthetic assessment in patients with high anaesthetic risk.The use of GnRH analogues for 3 or 4 months prior to fibroid surgery (hysterectomy or myomectomy) has been shown to reduce both uterine volume and fibroid size, correct iron deficiency anaemia, reduce intra-operative blood loss, diminish the need to perform a midline incision and increas the possibility of vaginal hysterectomy in selected cases [7,9]. Little is known about volume reduction for giant fibroids when GnRH analogues have been used.…”

Section: Pre-operative Phasementioning

confidence: 98%

Giant uterine leiomyomas: dilemmas in surgical management

et al. 2005

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Section: Pre-operative Phasementioning

confidence: 98%

Giant uterine leiomyomas: dilemmas in surgical management

et al. 2005

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“…A heavy uterus with large myoma hinders access to the uterine pedicle with rigid laparoscopic instruments and makes exposure of uterine vessels difficult. In this situation, a preoperative gonadotropin-releasing hormone cycle may help to perform TLH by decreasing size of myoma [32,33]. …”

Section: Discussionmentioning

confidence: 99%

Factors Determining Conversion to Laparotomy in Patients Undergoing Total Laparoscopic Hysterectomy

Park

Cho

Kim³

2010

Gynecol Obstet Invest

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Aims: To identify the risk factors determining conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases. Methods: We retrospectively reviewed medical records of 288 patients that underwent TLH during the first 2 years of performing TLH at Kang-Nam Sacred Heart Hospital. Twenty-three cases were converted to laparotomy. We compared patient characteristics, indications for hysterectomy, operation time, estimated blood loss, adhesion, uterine weight and postoperative complications between failed and successful groups. Results: The rate of conversion to laparotomy was 8%. There were no differences in patient characteristics between the two groups. Independent risk factors for conversion were adhesion and uterine weight. The most common cause of the conversion to laparotomy was adhesions (p = 0.000). Uterine weight was found to be heavier in the failed group (331.5 ± 157.1 vs. 270.3 ± 132.5 g, p = 0.038). Estimated blood loss was greater in the failed group (455.6 ± 143.7 vs. 304.2 ± 45.8 ml, p = 0.047). Bladder injury occurred in the failed group more frequently than in the successful group (p = 0.024). Conclusion: An awareness of risk factors for conversion is important for better patient selection for TLH. Indirect measurement of uterine weight by sonography and detailed history taking is helpful in determining the appropriate hysterectomy route.

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“…The long treatment times for patients with large volume fibroids excluded these patients from earlier trials. GnRH is well known to reduce fibroid size [22]. This study used GnRH analogues for 3 months prior to FUS to reduce the fibroid size with the hope that this would allow such patients an alternative to conventional therapies.…”

Section: Clinical Results and Discussionmentioning

confidence: 99%

“…The symptoms vary depending on the size, position and number of fibroids, but commonly include: menorrhagia, dysmenorrhoea, dyspareunia and symptoms related to the pressure effects on the urinary and gastro-intestinal tracts. As these tumours are dependent on gonadal steroid hormones, they reduce in size after the menopause, and with the use of gonadotrophin releasing hormone analogues, which will induce a premature but temporary menopause [22]. Uterine fibroids are most commonly located intramurally, but may also be subserosal, (where they may be pedunculated), or lie in the submucosa.…”

Section: Uterine Fibroidsmentioning

confidence: 99%

Thermal ablation of uterine fibroids using MR-guided focused ultrasound-a truly non-invasive treatment modality

Chapman

Haar

2007

Eur Radiol

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Uterine fibroids are a significant source of morbidity for women of reproductive age. Definitive treatment has traditionally been a hysterectomy, but increasingly women are not prepared to undergo such an invasive procedure for a benign and usually self-limiting condition. Although a number of minimally invasive techniques are now available, focused ultrasound has a considerable advantage over them as it is completely non-invasive and does not require an anaesthetic. Improvements in imaging techniques, particularly magnetic resonance imaging (MRI), have enabled the accurate planning, targeting and monitoring of treatments. We review the early experience of focused ultrasound surgery for the treatment of fibroids, and, in particular, the results of the recent phase I, II and III multi-centre clinical trials. These trials and other studies which demonstrate that MR-guided focused ultrasound ablation is feasible, safe and appears to have an efficacy that is comparable with other treatment modalities are described. This technique has the advantages of being non-invasive and being deliverable as an out-patient procedure.

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Efficacy of pre‐operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review

Cited by 188 publications

References 23 publications

Giant uterine leiomyomas: dilemmas in surgical management

Giant uterine leiomyomas: dilemmas in surgical management

Factors Determining Conversion to Laparotomy in Patients Undergoing Total Laparoscopic Hysterectomy

Thermal ablation of uterine fibroids using MR-guided focused ultrasound-a truly non-invasive treatment modality

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