Laparoscopic assisted robotic myomectomy of a huge myoma; Does robotic surgery change the borders in minimally invasive gynecology?

Takmaz, Özgüç; Gündoğan, Savaş; Ozbasli, Esra; Karabük, Emine; Naki, M. Murat; Köse, Faruk; Güngör, Mete

doi:10.4274/jtgga.galenos.2019.2019.0029

Cited by 4 publications

(4 citation statements)

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“… 2 – 4 Minimally invasive myomectomy (MIM) is feasible even in cases with large fibroids. 5 Although the use of MIS hysterectomy, has increased, 6 there is still little data regarding overall utilization of MIM. Most existing data come from studies exploring changes in practice after the FDA power morcellation recommendation.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Frost¹,

McMahon²,

Smith³

et al. 2021

JSLS

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Background and Objectives: This study aims to characterize the utilization of minimally invasive myomectomy in the United States and to identify the patient and hospital factors associated with surgical approach to myomectomy. Methods: This is a cross-sectional study using the National Inpatient Sample database. We extracted women aged 18–50 years who underwent open and minimally invasive (laparoscopic and robotic) myomectomy (MIM) from January 1, 2010–December 31, 2014. Descriptive statistics were obtained for patient and hospital characteristics. We then performed multivariable logistic regression to examine the association of patient (age, race, insurance status, median household income) and hospital (bed size, teaching status, for-profit status, census region, cases volume) characteristics with the likelihood of undergoing MIM. Results: Of 114,850 myomectomy cases, 8,330 (7%) underwent MIM and 106,520 (93%) were open. Over time, the proportion of MIM remained very low and slightly decreased from 8.2% in 2010 to 6.1% in 2014 (p-for-trend: 0.001). Most hospitals performed few MIM per year, with 50% performing five or less, and 25% performing three or fewer per year. African American, Hispanic, and women of other races were less likely to undergo MIM compared to Caucasian women (adjusted odds ration [OR] 0.57, 95% confidence interval [CI] 0.50–0.64; 0.71, 95% CI 0.60–0.83; 0.62, 95% CI 0.52–0.74, respectively). Women in the West (adjusted odds ratio (aOR) 1.23, 95% CI 1.04–1.46) and Midwest (aOR 1.27, 95% CI 1.07–1.52) had higher odds of undergoing MIM. Conclusion: MIM appears to be an underutilized modality, accounting for less than10% of myomectomies. This underutilization disproportionally affects minority women.

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Section: Introductionmentioning

confidence: 99%

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Frost¹,

McMahon²,

Smith³

et al. 2021

JSLS

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“…Surgery is widely used in clinical treatment, and mainly involves myomectomy or hysterectomy, including myomectomy through hysteroscopy, myomectomy through open or laparoscopy, uterine artery embolization, and interventions to induce thermal ablation of UFs under radiological or ultrasound guidance ( 21 ). Among them, LM has been widely used in clinical practice owing to its small abdominal wall incision, aesthetics, minimal trauma, and faster postoperative recovery ( 22 , 23 ). However, regardless of the treatment method, complications such as postoperative bleeding, recurrence or complications of urological diseases, and even adverse effects on fertility may still occur after treatment ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of risk factors for postoperative bleeding and recurrence after laparoscopic myomectomy in patients with uterine fibroids: a retrospective cohort study

Han¹,

Su²,

Shang³

et al. 2023

Gland Surg

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Background: In Asia, the incidence of uterine fibroids (UFs) in women is as high as 1.278%. However, there are few analyses of the prevalence and independent risk factors for bleeding and recurrence after laparoscopic myomectomy (LM). This study aimed to analyze the clinical characteristics of patients with UF and identify the independent risk factors for postoperative bleeding and recurrence after LM, so as to provide a reference basis for improving the quality of life of patients. Methods: Based on our exclusion and inclusion criteria, we retrospectively analyzed a total of 621 patients who developed UF from April 2018 to June 2021. The t-test, analysis of variance (ANOVA), and chisquare test were used to analyze the relationship between the clinical characteristics of the patients and postoperative bleeding as well as recurrence. Binary logistic regression was used to analyze the independent risk factors for the occurrence of postoperative bleeding and fibroid recurrence in patients. Results: The rates of postoperative bleeding and recurrence after LM for uterine fibroids were 4.5% and 7.1%, respectively. Binary logistic regression analysis showed that fibroid size [odds ratio (OR) =5.502, P=0.003], maximum fibroid type (OR =0.293, P=0.048), pathological type (OR =3.673, P=0.013), preoperative prothrombin time level (OR =1.340, P=0.003), preoperative hemoglobin level (OR =0.227, P=0.036), surgery time (OR =1.066, P=0.022), intraoperative bleeding (OR =1.145, P=0.007), and postoperative infection (OR =9.540, P=0.010) were independent risk factors for postoperative bleeding; meanwhile, body mass index (BMI) (OR =1.268, P=0.001), age of menarche (OR =0.780, P=0.013), fibroid size (OR =4.519, P=0.000), fibroid number (OR =2.381, P=0.033), maximum fibroid type (OR =0.229, P=0.001), pathological type (OR =2.963, P=0.008), preoperative delivery (OR =3.822, P=0.003), preoperative C-reactive protein (CRP) level (OR =1.162, P=0.005), intraoperative ultrasonography (OR =0.271, P=0.002), postoperative gonadotropin-releasing hormone agonist treatment (OR =2.407, P=0.029), and postoperative infection (OR =7.402, P=0.005) were independent risk factors for recurrence. Conclusions: At present, there is still a high probability of postoperative bleeding and recurrence after LM for UF. Clinical work should pay close attention to clinical features. Adequate preoperative examination to improve surgical precision, and strengthen postoperative care and education, thus reducing the probability of postoperative bleeding and recurrence in patients.

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“…In a case report published in 2015, a 17-cm myoma was successfully removed with laparoscopic myomectomy [ 1 ]. In addition, Takmaz et al [ 6 ] also reported a case of successful removal of a 16-cm-sized myoma using RALM in 2019. In a previous retrospective study [ 7 ], it was asserted that the size of myoma that can be excised by laparoscopy may be limited to less than 8 cm or 10 cm.…”

Section: Discussionmentioning

confidence: 99%

The Largest Uterine Leiomyoma Removed by Robotic-Assisted Laparoscopy in the Late Reproductive Age: A Case Report

Jeong

Lee

et al. 2021

J Menopausal Med

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Uterine leiomyoma is a very common gynecological tumor in the reproductive years. Recent studies have shown that surgical treatment of uterine leiomyoma using robotic-assisted laparoscopic myomectomy (RALM) is associated with significantly fewer complications, lower estimated blood loss, fewer conversions, and less bleeding than conventional laparoscopic myomectomy. This study reports the case of a giant uterine leiomyoma treated using RALM. A 50-year-old woman was referred to our outpatient clinic with progressive abdominal distension. Ultrasonography and magnetic resonance imaging were performed and showed a markedly enlarged uterus containing a 28-cm uterine myoma. RALM confirmed the 28-cm subserosal myoma on the posterior wall of the uterus. The myoma was enucleated, and the myometrial and serosal defect was repaired with a continuous suture using barbed suture materials. The entire myoma was removed using an electric morcellator. The operation lasted for 190 minutes. The total weight of the removed myoma was 3,262 g, and uterine leiomyoma was pathologically diagnosed. There were no postoperative complications. Although the treatment of huge myomas using RALM is controversial and technically demanding, we successfully performed RALM in a patient with a large myoma. This case confirms the efficiency, reliability, and safety of a robotic-assisted laparoscopic approach for removing a huge myoma. In a well-selected case, RALM can be performed by experienced surgeons regardless of the size of fibroids.

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Laparoscopic assisted robotic myomectomy of a huge myoma; Does robotic surgery change the borders in minimally invasive gynecology?

Cited by 4 publications

References 0 publications

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Predictors of Minimally Invasive Myomectomy in the National Inpatient Sample Database, 2010–2014

Analysis of risk factors for postoperative bleeding and recurrence after laparoscopic myomectomy in patients with uterine fibroids: a retrospective cohort study

The Largest Uterine Leiomyoma Removed by Robotic-Assisted Laparoscopy in the Late Reproductive Age: A Case Report

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