Hemostatic Techniques for Myomectomy: An Evidence-Based Approach

Hickman, Lisa C.; Kotlyar, Alexander; Shue, Shirley; Falcone, Tommaso

doi:10.1016/j.jmig.2016.01.026

Cited by 60 publications

(40 citation statements)

References 41 publications

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“…Additionally, numerous studies evaluating modifications of the traditional myomectomy techniques (e.g. use of vasoconstrictors, modifications of suturing technique, temporary uterine artery occlusion) have consistently indicated that shorter operating times were associated with decreased perioperative blood loss [16–21]. A recent study demonstrated impressively that the total operating time depends not only on the organ pathology but is a result of steps and delays including – not always predictable or avoidable – “microcomplications” (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The LM is generally associated with less morbidity (e.g. less postoperative pain, rapid recovery, shorter hospital stay, smaller incisions) as compared with laparotomy [8, 11, 12], but the intraoperative blood loss remains a critical challenge in LM [6, 13–16]. …”

Section: Introductionmentioning

confidence: 99%

“…application of vasoconstrictive agents, hemostatics, barbed sutures or mechanical maneuvers [16–21]), the average intraoperative blood loss during LM is between 100 and 450 ml (ranging from 20 to 2000 ml) [7, 10, 14, 16, 21, 22] and can be higher as in laparoscopic hysterectomy for similar indications [15]. …”

Section: Introductionmentioning

confidence: 99%

“…Walid and Heaton [9] identified solely the myoma diameter as the main predictor of blood loss in LM. Identification of factors influencing perioperative blood loss in LM is crucial for reducing the risk of transfusions, complications and conversions to hysterectomy [16]. …”

Section: Introductionmentioning

confidence: 99%

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Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

Watrowski

Jäger

Förster

2017

Videosurgery and Other Miniinvasive Techniques

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IntroductionLaparoscopic myomectomy (LM) can be associated with significant bleeding.AimTo identify factors influencing the postoperative hemoglobin (Hb) drop after LM.Material and methodsThis is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015.ResultsThe median age of the patients was 37 (23–53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5–12) cm. The mean surgical time was 83 ±38 (35–299) min. The median number of sutures was 3 (1–11). The mean postoperative Hb drop was 1.6 ±1.2 (0–6) g/dl, and the mean estimated blood loss was 261 ±159 (50–1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients’ age or number of intramural myomas. In the multivariable analysis, the surgical time (β = 0.395, p < 0.001), diameter of the largest myoma (β = 0.292, p = 0.03) and preoperative Hb concentration (β = 0.299, p < 0.001) predicted the postoperative Hb change.ConclusionsSurgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

Watrowski

Jäger

Förster

2017

Videosurgery and Other Miniinvasive Techniques

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“…Numerous medical and surgical techniques have been developed to maintain hemostasis during nonhysteroscopic myomectomy. 12 Pharmacological agents such as intravaginal prostaglandins and oxytocin infusion are often used to reduce blood loss. However, their effects may not be completely controlled and may have negative results.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Danilyants¹,

Mamik

MacKoul³

et al. 2020

J of Obstet and Gynaecol

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Aim To compare the safety protocols and operative outcomes of women undergoing laparoscopic‐assisted myomectomy (LAM) by the same surgeons at a freestanding ambulatory surgery center (ASC) versus a hospital outpatient setting. Methods Retrospective chart review of all women ≥18 years old with symptomatic leiomyoma, who underwent LAM with uterine artery occlusion or ligation for blood loss control, at a freestanding ASC between 2013 and 2017, and an outpatient hospital setting between 2011 and 2013, both serving the metropolitan Washington, DC area. The procedures were performed by two minimally invasive gynecologic surgical specialists from a single practice. The safety protocols of each setting were reviewed to identify similarities and differences. Results A total of 816 LAM cases were analyzed (ASC = 588, hospital = 228). The rate of complications was comparable across settings, as was the average myoma weight (ASC = 396.2 g; hospital = 461.5 g; P = 0.064). Operative time was significantly shorter at the ASC: 68 min (95% CI 66–70) versus 80 min at hospital (95% CI 76–84), P < 0.0001. Ambulatory surgery center and hospital protocols differed in limits of preoperative hemoglobin (minimum 9.0 g/dL, 7.5 g/dL respectively), lower nurse/patient ratio in PACU, and were similar in intraoperative surgical safety standards. Conclusion Laparoscopic‐assisted myomectomy can be performed safely and effectively by skilled surgeons at a freestanding ASC, even in patients with morbid obesity or large leiomyoma.

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Comparison between the vascular control technique and conventional technique for reducing operative blood loss during robot‐assisted myomectomy

Song

Han

Sung

2019

Robotics Computer Surgery

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Background: This retrospective study aimed to compare the surgical outcomes and morbidity of the vascular control technique in robotic myomectomy with the conventional technique.Methods: Thirty-two consecutive patients who underwent robotic myomectomy using laparoscopic vascular clamps in 2017 to 2019 (the practice change cohort) were retrospectively comparted with 32 case-matched consecutive patients who underwent the conventional robotic myomectomy (the historical cohort). The primary outcome was the operative blood loss and hemoglobin change. Results:The two cohorts had similar baseline characteristics. The mean operative blood loss and hemoglobin changes were lower in the practice change cohort than in the historical cohort (P < .001 and P = .005, respectively). Other postoperative outcomes were similar between two cohorts. Conclusion:The vascular control technique in robotic myomectomy appears to be effective and safe in the management of selective patients with symptomatic myomas. KEYWORDS blood loss, robotic myomectomy, uterine myomas, vascular control 1 | INTRODUCTION Uterine myoma affects 25% of women worldwide and is the most common benign uterine tumor in women of reproductive age. 1,2 If the medical treatments are not effective for the women who have symptoms or infertility, surgical treatments should be considered. Surgical treatments for uterine myoma included myomectomy for women who desire pregnancy in the future or want to preserve their uterus, and hysterectomy for those who have completed childbearing. 3 The accomplishment of myomectomy by either conventional laparoscopy or robot-assisted laparoscopy has been often questioned for causing excessive operative blood loss and, as a direct consequence, blood transfusion, conversion to hysterectomy, postoperative anemia, and delayed recovery. 1-4 Therefore, various surgical techniques have been devised to reduce blood loss during myomectomy in more safe and faster way. 5 There are many recent studies about new methods how to achieve simultaneous temporary occlusion of both uterine and ovarian (or utero-ovarian) arteries during myomectomy more effectively in regard to the surgical time and complications. 6,7 However, the application of this technique to clinical practice (especially in robotic myomectomy) has not been investigated in terms of its efficacy and safety. Therefore, we designed this study to evaluate the feasibility and safety of the vascular control technique in robot-assisted laparoscopic myomectomy and compare the surgical outcomes and morbidity to the conventional techniques. (Figure 1)

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Hemostatic Techniques for Myomectomy: An Evidence-Based Approach

Cited by 60 publications

References 41 publications

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

Laparoscopic‐assisted myomectomy: Surgery center versus outpatient hospital

Comparison between the vascular control technique and conventional technique for reducing operative blood loss during robot‐assisted myomectomy

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