Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula

Osorio, Walter; Posada, Natalia; Cano, J.J. Morales-De; Tamayo, Sergio; Giraldo-Moreno, Juan Luis

doi:10.1016/j.fertnstert.2020.09.028

“…This is due to the comprehensive rehabilitation nursing mode could make patients understand the operation process and rise perioperative cooperation points by preoperative psychological counseling and health education, thus better cooperating with the operation of medical staff. By guiding patients with reasonable diet, comprehensive rehabilitation nursing mode could promote wound healing and gastrointestinal function recovery, so as to accelerate the recovery process [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Liu¹,

Gao²,

Li³

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. Uterine fibroids are most common in women aged 30-50 and are the most common benign gynecological tumors. Relevant data suggest that about 25% of patients with uterine fibroids are at childbearing age. Uterine fibroids not only cause the discomfort symptoms, and affect the pregnancy, but also have certain malignant transformation risk, thus needed to be treated positively and promptly. Aim. This study is aimed at exploring the effect of laparoscopic myomectomy and comprehensive rehabilitation nursing on patients with uterine fibroids. Methods. The clinical data of 110 cases of uterine fibroids admitted to our hospital from August 2019 to December 2021 were analyzed retrospectively, and they were divided into two groups according to postoperative rehabilitation strategies. Both groups were treated with laparoscopic myomectomy. The A group was treated with routine rehabilitation strategy, while the B group was treated with comprehensive rehabilitation nursing strategy. The differences in operation-related indicators, stress factors, inflammatory factors, nutritional indicators, knowledge mastery, occurrence of adverse symptoms and pain scores, negative emotion scores, nursing satisfaction, and simplified comfort status scale (GCQ) scores between the two groups under nursing strategies were compared. Results. The postoperative exhaust time ( 13.14 ± 2.03 ) h, bed time ( 9.86 ± 1.94 ) h, postoperative hospital stay ( 4.37 ± 1.31 ) d, and total hospital stay ( 6.78 ± 1.69 ) d in the B group were shorter than those in the A group, and the hospitalization expenses ( 0.74 ± 0.25 ) million were less than those in the A group ( P < 0.05 ). Before operation, stress factors, inflammatory factors, and nutritional indexes were compared between the two groups ( P > 0.05 ). On the 3rd day after operation, tumor necrosis factor-α (TNF-α), cortisol (Cor), norepinephrine (NE), and interleukin-1β (IL-1β) in the two groups showed a significantly upward trend compared with those before operation, and albumin and transferrin were significantly fell compared with those before operation. However, the values of stress factor and inflammatory factor in the B group were significantly lower than those in the A group, and the values after the decrease of nutritional index were significantly higher than those in the A group ( P < 0.05 ). The pain scores at 24 h, 48 h, and 72 h after operation in the B group were significantly lower than those in the A group ( P < 0.05 ). Negative emotions, nursing satisfaction, and GCQ scores were compared between the two groups before intervention ( P > 0.05 ). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the two groups were significantly lower than those before the intervention, and the scores of nursing satisfaction and GCQ were higher than those before the intervention. The values of negative emotions in the B group after the decline were significantly lower than those in the A group, while the values of nursing satisfaction and GCQ after the increase were higher than those in the A group ( P < 0.05 ). The excellent and good rate of knowledge acquisition in the B group was 94.55% (52/55), which was significantly higher than 78.18% (43/55) in the A group ( P < 0.05 ). The incidence of adverse symptoms in the B group was 9.09% (5/55), which was lower than 21.82% (12/55) in the A group, while the difference was not statistically significant ( P > 0.05 ). Conclusion. Laparoscopic myomectomy combined with comprehensive rehabilitation nursing can reduce the postoperative stress state of patients with uterine fibroids, improve patient satisfaction, reduce adverse emotions, and promote rehabilitation.

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“…This device has two lumens through which the Bettochi's hysteroscope and a laparoscopic tenaculum forceps can be introduced into the uterine cavity simultaneously avoiding the retrograde fluid loss and allowing comfortable maneuvering with both instruments to perform previously enucleated fibroid removal under direct visualization. Absence of thermal damage to neighboring myometrium and the use of isotonic fluid distention media diminishes risks of surgical complications, offers a rapid recovery and efficiently restores the intrauterine microenvironment necessary to allow embryo implantation [57]. Besides, the need for second look hysteroscopy or additional surgical steps is less frequent.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Fibroids and Infertility

Moreno¹,

López²

2021

Infertility and Assisted Reproduction

1

0

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Uterine fibroids (also known as leiomyomas or myomas) are the most common pelvic tumors, affecting more than 70% of women over 70 years of age and although most are asymptomatic, some women may experience symptoms, depending on their location and size, which can alter your quality of life, such as abnormal uterine bleeding, anemia, pelvic pain and pressure, dyspareunia, increased urinary frequency and constipation. Its relationship with infertility has been controversial and, although insignificant for subserous fibroids, it appears that submucosal and intramural fibroids that distort the endometrial cavity can affect embryo implantation and are associated with an increased risk of early pregnancy loss. Its treatment will depend on the patient’s symptoms, size, location, whether it is one or multiple, and whether or not she suffers from infertility. It is clear that submucosal fibroids have a negative impact on fertility and with respect to intramural fibroids it is known that fibroids larger than 4 cm alter the probability of pregnancy, however there are studies that show that even smaller or multiple fibroids could affect pregnancy rates. There are multiple options for the treatment of fibroids; however, patients who are candidates for expectant, medical or surgical management should be individualized, and especially if they are going to be taken to surgery, an excellent mapping of fibroids prior to surgical intervention is recommended. Minimally invasive surgery continues to be the approach of choice, it should be left for the open approach in cases in which Laparoscopy is contraindicated or the patient with multiple myomatosis.

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“…Submucosal myomas (FIGO type 0, 1, 2) that derive from myometrial cells just below the endometrium ( 3 ) are estimated to be the cause of 5-10% of cases of irregular bleeding, pain, subfertility and infertility ( 4 , 5 ). The advancement in endoscopic surgical techniques has resulted in an improved ability to remove submucous uterine fibroids ( 6 , 7 ). At present, the gold standard treatment for submucous myoma is hysteroscopic myomectomy ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…The advancement in endoscopic surgical techniques has resulted in an improved ability to remove submucous uterine fibroids ( 6 , 7 ). At present, the gold standard treatment for submucous myoma is hysteroscopic myomectomy ( 7 ). Different techniques and instruments have been introduced to facilitate the removal of submucosal myomas ( 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

“…At present, the gold standard treatment for submucous myoma is hysteroscopic myomectomy ( 7 ). Different techniques and instruments have been introduced to facilitate the removal of submucosal myomas ( 7 , 8 ). Since hysteroscopic morcellator devices, for example the Myosure, and/or other modern interventional and expensive facilities are not widely available, in many hospitals, submucosal myoma removal is still performed using a resectoscope ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Blooming phenomenon: a rarity, but a dilemma in hysteroscopic resection of myomas

Tahermanesh¹,

Hanjani²,

Shahriyari³

et al. 2022

J Turkish German Gynecol Assoc

0

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Modern surgical technologies allow gynecologists to treat most submucosal myomas hysteroscopically by some form of resection. What appears on imaging or direct visualization to be a submucosal myoma can be a single tumor, or may represent multiple smaller myomas appearing as one, compacted together in a typical pseudo capsule. During myoma resection, the effect of the media used to induce distension can vary, depending on the morphology of the myomas. After starting resection, the pressure of the distending media can push truly solitary myomas to somewhat flatten against the uterine wall. However, in the second type of myoma, the fluid can displace the myomas into the uterine cavity, an appearance similar to the blooming of a flower. The tip of the hysteroscope may enter the dissected spaces between the myomas, which impairs the panoramic view. This phenomenon may cause inadequate treatment of the myomas encountered during hysteroscopic myomectomy. In this study, the “Blooming phenomenon” is introduced, and the problems created by this phenomenon and solutions for its management are considered.

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Hysteroscopic myomectomy for submucosal type 2 fibroids with cold enucleation technique and complete fibroid extraction using a double-lumen intracervical cannula

Cited by 6 publications

References 4 publications

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Application Effect of Laparoscopic Myomectomy and Comprehensive Rehabilitation Nursing on Patients with Uterine Fibroids

Fibroids and Infertility

The Blooming phenomenon: a rarity, but a dilemma in hysteroscopic resection of myomas

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