Laparoscopic myomectomy with uterine artery ligation: Review article and comparative analysis

Sinha, Rakesh; Sundaram, Meenakshi; Mahajan, Chaitali; Raje, Shweta; Kadam, Pratima; Rao, Gayatri

doi:10.4103/0974-1216.85272

Cited by 13 publications

(4 citation statements)

References 15 publications

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“…The vessel diameters predicted by the model are within the expected range (large variations) given in literature 28 , 64 , 65 , 66 , 67 , 68 , 69 , 70 (shown in Table 3 ). The model predicts that the spiral arteries of patient 2 are significantly under‐adapted compared with the other patients and to what is expected from literature.…”

Section: Resultssupporting

confidence: 82%

Personalising cardiovascular network models in pregnancy: A two‐tiered parameter estimation approach

Carson

Warrander

Johnstone

et al. 2020

Numer Methods Biomed Eng

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Uterine artery Doppler waveforms are often studied to determine whether a patient is at risk of developing pathologies such as pre‐eclampsia. Many uterine waveform indices have been developed, which attempt to relate characteristics of the waveform with the physiological adaptation of the maternal cardiovascular system, and are often suggested to be an indicator of increased placenta resistance and arterial stiffness. Doppler waveforms of four patients, two of whom developed pre‐eclampsia, are compared with a comprehensive closed‐loop model of pregnancy. The closed‐loop model has been previously validated but has been extended to include an improved parameter estimation technique that utilises systolic and diastolic blood pressure, cardiac output, heart rate, and pulse wave velocity measurements to adapt model resistances, compliances, blood volume, and the mean vessel areas in the main systemic arteries. The shape of the model‐predicted uterine artery velocity waveforms showed good agreement with the characteristics observed in the patient Doppler waveforms. The personalised models obtained now allow a prediction of the uterine pressure waveforms in addition to the uterine velocity. This allows for a more detailed mechanistic analysis of the waveforms, eg, wave intensity analysis, to study existing clinical indices. The findings indicate that to accurately estimate arterial stiffness, both pulse pressure and pulse wave velocities are required. In addition, the results predict that patients who developed pre‐eclampsia later in pregnancy have larger vessel areas in the main systemic arteries compared with the two patients who had normal pregnancy outcomes.

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Section: Resultssupporting

confidence: 82%

Personalising cardiovascular network models in pregnancy: A two‐tiered parameter estimation approach

Carson

Warrander

Johnstone

et al. 2020

Numer Methods Biomed Eng

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“…Injection of ADH (vasopressin derivative solutions) or diluted adrenalin around the fibroid wall (extracapsular) causes blood vessels to constrict and minimizes the bleeding to facilitate dissection. Similarly, temporary bilateral uterine artery clipping can reduce blood supply and bleeding during myoma excision [ 71 ]. Additionally, the use of preoperative treatment to improve the hemoglobin concentration and diminish myoma size primarily applies to infertility cases where the myomas deform the cornua and the endometrial cavity.…”

Section: Discussionmentioning

confidence: 99%

Prevention and Management of Complications in Laparoscopic Myomectomy

Tanos

Berry

Frist

et al. 2018

BioMed Research International

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Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.

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“…2010; Sundaram et al. 2011). There are few studies that measure the diameters of veins, and hence they are either estimated from the literature (Burbank 2009) or the diameter of the vein is assumed to be 1.25 times larger than its corresponding artery (Mynard and Smolich 2015).…”

Section: Methodsmentioning

confidence: 99%

“…The physiological ranges for uterine vessel diameters have been measured between 2 mm and 6 mm (Sundaram et al. 2011). The diameter of the arcuate artery in the model is 4 mm, while in Clark et al.…”

Section: Methodsmentioning

confidence: 99%

A data-driven model to study utero-ovarian blood flow physiology during pregnancy

Carson

Lewis

Rassi

et al. 2019

Biomech Model Mechanobiol

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In this paper, we describe a mathematical model of the cardiovascular system in human pregnancy. An automated, closed-loop 1D–0D modelling framework was developed, and we demonstrate its efficacy in (1) reproducing measured multi-variate cardiovascular variables (pulse pressure, total peripheral resistance and cardiac output) and (2) providing automated estimates of variables that have not been measured (uterine arterial and venous blood flow, pulse wave velocity, pulsatility index). This is the first model capable of estimating volumetric blood flow to the uterus via the utero-ovarian communicating arteries. It is also the first model capable of capturing wave propagation phenomena in the utero-ovarian circulation, which are important for the accurate estimation of arterial stiffness in contemporary obstetric practice. The model will provide a basis for future studies aiming to elucidate the physiological mechanisms underlying the dynamic properties (changing shapes) of vascular flow waveforms that are observed with advancing gestation. This in turn will facilitate the development of methods for the earlier detection of pathologies that have an influence on vascular structure and behaviour. Electronic supplementary material The online version of this article (10.1007/s10237-019-01135-3) contains supplementary material, which is available to authorised users.

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Laparoscopic myomectomy with uterine artery ligation: Review article and comparative analysis

Cited by 13 publications

References 15 publications

Personalising cardiovascular network models in pregnancy: A two‐tiered parameter estimation approach

Personalising cardiovascular network models in pregnancy: A two‐tiered parameter estimation approach

Prevention and Management of Complications in Laparoscopic Myomectomy

A data-driven model to study utero-ovarian blood flow physiology during pregnancy

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