GnRH Agonist Treatment before Total Laparoscopic Hysterectomy for Large Uteri

Seracchioli, Renato; Venturoli, Stefano; Colombo, Filippo Maria; Bagnoli, A.; Vianello, F.; Govoni, F.; Guerrini, M; Gualerzi, B

doi:10.1016/s1074-3804(05)60254-x

Cited by 40 publications

(20 citation statements)

References 15 publications

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“…In addition, median blood loss was significantly less than that reported in the literature for patients undergoing vaginal, laparoscopic assisted vaginal, or abdominal hysterectomy procedures, but was comparable with those reported for total laparoscopic hysterectomy [4,17,21,22]. Reported investigations of conventional laparoscopic hysterectomy generally corresponded with our findings regarding the effect of large uterine weight on operative time and blood loss [20][21][22][23] but the effect was of greater magnitude than we observed for robotic hysterectomy. Other factors also affect blood loss, as in the three cases who received blood transfusion, which were notable for excessively prolonged procedures with two cases involving extensive adhesiolysis.…”

Section: Discussionsupporting

confidence: 88%

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

2011

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The objective of this study was to determine whether uterine weight affects the surgical outcomes of robot-assisted total laparoscopic hysterectomy (RH) procedures. The design of this study is retrospective cohort study. The classification of the study design is level II-2 evidence. The study setting is the Henry Ford Health System's Community Teaching Hospitals. One-hundred and thirty-five patients underwent RH for benign indications at one of two hospitals between January1, 2008, and June 1, 2010. Interventions were scheduled RH without concomitant uro-gynecologic procedures as the intention to treat. Patient demographics, age, height, weight, estimated blood loss (EBL), procedure duration, uterine weight, pathology, length of hospital stay (LOS), and any complications were obtained from a detailed review of electronic medical records. Uterine weight ranged from 47 to 1,290 g (<250 g, n = 87; 250-500 g, n = 28; >500 g, n = 18). Overall, uterine weight was highly correlated with procedure duration (r = .53, P < .001.). Median procedure duration increased from 150 min for the <250 g group, to 205 min for the 250-500 g group, and to 295 min for the >500 g group. Uterine weight was also moderately correlated with EBL (r = .30, P = .0005). Median EBL increased from 50 ml for uteri <250 g to 87.5 ml for the 250-500 g group, and 100 ml for the >500 g group. This correlation did not persist in the assessment of decrease in peri-operative hemoglobin (r = .09, P = .30). Ninety-one women had a LOS of 1 day (67.4%), 31 women had a LOS of 2 days (23%), and 13 women had a LOS of greater than 2 days (9.6%). Uterine weight was not correlated with LOS (r = .14, P = .10) and was not associated with increased major or minor complications (WRS P = .79) re-admission (WRS P = .35), or blood transfusion (n = 3). RH can be performed on patients with large uteri exceeding 500 g without associated adverse outcomes. Although procedure duration is increased, there is no significant effect on EBL and no increase in the occurrence of complications or length of stay.

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Section: Discussionsupporting

confidence: 88%

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

2011

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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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“…In fact, these pathologies, after an adequate treatment with GnRH-a, usually improve greatly; it has to be underlined that the diseases treated with GnRH-a (hyperplasia, polyps, endometriosis, myomata) partially remit. It is also known that an adequate cycle of therapy with GnRH-a will reduce bleeding during myomectomy or hysterectomy [18,19] . In conclusion, administration of LA can induce a significant constant and unique regression of the endometrial mucosa and it can be used in the treatment of many benign hormone-sensitive disorders of the female genital system.…”

Section: Discussionmentioning

confidence: 99%

Morphologic Patterns of Human Endometrial Epithelium in Women with Uterine Myomata Treated with Leuprorelin Acetate

Palmara

Triolo

Benedetto

et al. 2009

Gynecol Obstet Invest

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Aim: We studied morphologic modifications of the endometrium induced by leuprorelin acetate, a gonadotropin-releasing hormone agonist, in women with uterine myomata. Methods: Transmission and scanning electron microscopy observations were performed after 2 or 6 cycles of therapy (every 28 days). Results: A near-normal endometrium was observed after 2 months of therapy, while treatment with 6 cycles of leuprorelin acetate induced a uniform morphologic regression of the uterine mucosa. Conclusions: The study demonstrates that leuprorelin acetate induces a unique and time-dependent regression of the endometrial mucous membrane.

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GnRH Agonist Treatment before Total Laparoscopic Hysterectomy for Large Uteri

Cited by 40 publications

References 15 publications

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

Does size matter? The effect of uterine weight on robot-assisted total laparoscopic hysterectomy outcomes

Factors Determining Conversion to Laparotomy in Patients Undergoing Total Laparoscopic Hysterectomy

Morphologic Patterns of Human Endometrial Epithelium in Women with Uterine Myomata Treated with Leuprorelin Acetate

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