Laparoscopic myomectomy and pregnancy outcome in infertile patients

Ribeiro, Sofia; Reich, Harry; Rosenberg, Jay; Guglielminetti, Enrica; Vidali, Andrea

doi:10.1016/s0015-0282(98)00483-x

Cited by 91 publications

(40 citation statements)

References 18 publications

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“…More recently, the indications have been modified and extended because of the improvement in laparoscopic technique and surgical skills 5 . This allows a greater number of women with fibroids to be treated with operative laparoscopy rather than the traditional abdominal approach.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the choice between laparotomy and operative laparoscopy is based on a number of restrictions such as the number, size and location of the fibroids 4 . These parameters can limit the use of the laparoscopic approach, but no definitive criteria have been established 5 . It is well known that intramural fibroids, reaching the uterine cavity, might represent a contraindication to laparoscopic myomectomy, due to intra-and post-operative bleeding and inadequate closure of the endometrium/ myometrium 6,7 .…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Seracchioli

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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Objective The purpose of the study was to evaluate the post-operative course and follow up of women who had undergone laparoscopic removal of intramural fibroids penetrating the uterine cavity. Design Retrospective study.Setting Center for Reconstructive Pelvic Endosurgery, Italy.Population Thirty-four women with fibroids penetrating the uterine cavity. Methods Laparoscopic myomectomy.Main outcome measures Feasibility and safety of surgical technique, length of operation, blood loss, intraor post-operative complications, length of hospital stay, resolution of symptoms and future obstetric outcome. Results The mean operative time was 79 (SD 30) minutes; the mean reduction in haemoglobin was 1.1 F 0.9 g/dL. No intra-or post-operative complications were observed. The average post-operative stay in hospital was 54 (SD 22) hours. Nineteen (73%) out of 26 patients who had experienced symptoms prior to surgery reported resolution of these symptoms post-operatively. All patients resumed work within a mean time of 20 (SD 8) days. Among 23 of the 32 patients attempting pregnancy during the follow up period, nine (39%) conceived within one year. Seven pregnancies went to term without complications. Conclusion The clinical results of this study suggest that laparoscopic myomectomy for intramural fibroids penetrating the uterine cavity is a safe procedure, providing well known advantages of minimal access surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Seracchioli

2003

BJOG: An International Journal of Obstetrics and Gynaecology

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“…16,32,33,47 Since adhesion formation following myomectomy may reduce fertility, formal secondlook laparoscopic studies in nonpregnant women following RALM may be needed for a more definitive measure of postoperative adhesion formation. A limitation of our study is the inability to generalize these findings to other practices.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Jetty¹

2015

WJOLS

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Review study question: What are the characteristics of the pregnancy outcomes in women undergoing robot-assisted laparoscopic myomectomy (RALM) for symptomatic leiomyomata uteri?Summary answer: Despite a high prevalence of women with advanced maternal age, obesity and multiple pregnancy, the outcomes are comparable with those reported in the literature for laparoscopic myomectomy. Study design: Review study.Participants/material, setting, methods: An extensive search for articles related to the topic and review the studies. Main results:The mean time to conception was 12 to 18 months. Assisted reproduction techniques were employed in 22 to 24% of these women. Spontaneous abortions occurred in 18 to 20%. Preterm delivery prior to 35 weeks of gestational age occurred in 17%. One uterine rupture was documented in all studies together. Pelvic adhesions were discovered in 11 to 16% of patients delivered by cesarean section. Higher preterm delivery rates were significantly associated with a greater number of myomas removed and anterior location of the largest incision. None of the myoma characteristics were related to spontaneous abortion.

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“…2,4 A laparoscopia vem ganhando espaço nos últimos tempos, com a melhoria da técnica e com o aumento do número de médicos capazes de realizá-la de forma eficaz. 4,10,12 É observada diminuição da dor e do tempo de recuperação pós-operatórios com o uso dessa via. Alguns autores, porém, postulam que a opção pela laparoscopia resulta em maior taxa de complicações, como a rotura uterina em uma gestação subseqüente, devido à maior dificuldade de sutura do miométrio.…”

Section: Tratamento Hormonalunclassified

Miomas e infertilidade: bases fisiopatológicas e implicações terapêuticas

Silva

Seibel

Capp

et al. 2005

Rev. Bras. Saude Mater. Infant.

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Objectives: to analyze evidences in medical literature concerning the possible relation between uterine leiomyomas and infertility, and the advantages /disadvantages of the different treatments available.Methods: literature review using the key words (MeSh terms) "leiomyomas", "infertility", "treatment", "myomectomy", "pregnancy" in "Pubmed" and "The Cochrane Library 2003" database. The search period was from 1989 through 2003.Results: although there are contradictory results, the majority of authors determined a possible cause-consequence relation between some types of leiomyomas and reproductive impairement. Concerning therapeutics, we were able to clearly place myomectomy as being the surgical technique with the best results. Surgical approaches used for this procedure did not show significant differences from each other, except for submucosal myomas, where histeroscopy is more effective. Other existent treatment options do not seem to be indicated for infertile patients with uterine leiomyomas.Conclusions: the possible association between myomas and reproductive impairment needs to be further investigated. Success indicated by gestational rates following surgical resection, mainly in patients with submucosal myomas, are an indication that they do have a role in infertility etiology. Concerning the treatment, it became clear that myomectomy is the procedure of choice for all patients desiring to become pregnant. Key words Myomas, Infertility, female, Pregnancy ResumoObjetivos: analisar evidências da literatura médi-ca que avaliam a relação entre miomas uterinos e infertilidade, assim como as vantagens e desvantagens dos diferentes tipos de tratamentos disponíveis.Métodos: foi realizada uma revisão da literatura utilizando os termos (MeSh terms) "miomas", "infertilidade", "tratamento", "miomectomia", "gestação", na base de dados "Pubmed" e na "The Cochrane Library 2003". O período analisado foi de 1989 a 2003.Resultados: apesar de alguns resultados contraditórios, a maioria dos autores relata uma possível relação de causa-conseqüência entre determinados tipos de miomas e distúrbios reprodutivos. Em relação à terapêutica, observa-se claramente que a miomectomia representa a técnica cirúrgica com melhores resultados, não havendo diferença significativa entre as vias de acesso utilizadas, com exceção da miomatose submucosa, situação em que a via histeroscópica é preferida. As opções não-cirúrgicas de tratamento existentes não parecem ter indicação em pacientes inférteis.Conclusões: a possível associação entre miomas e distúrbios reprodutivos necessita de melhores investigações. O incremento nas taxas de gestação após ressecção cirúrgica de miomas submucosos leva-nos a acreditar que esses tumores tenham papel na etiologia da infertilidade. Em miomas de outras localizações, entretanto, a relação com infertilidade não é tão clara. A miomectomia é o procedimento de escolha para as pacientes que ainda desejam engravidar.Palavras-chave Mioma, Infertilidade feminina, Gravidez

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Laparoscopic myomectomy and pregnancy outcome in infertile patients

Cited by 91 publications

References 18 publications

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Pregnancy Outcomes following Robot-assisted Laparoscopic Myomectomy

Miomas e infertilidade: bases fisiopatológicas e implicações terapêuticas

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