Morbidity of abdominal myomectomy: Dispelling the myth

MR-guided focused ultrasound for the treatment of adenomyosis: current insights

“…Losing their uterus can cause significant psychosocial effects, 12,13 in particular concerns regarding the association of a perceived loss of femininity. 14 The option of surgical excision may be considered for those who wish to preserve their uterus, but the procedure is more challenging than for myomectomy. 15 If there is a defined adenomyoma lesion (focal adenomyosis), surgical excision may be possible; however, in cases of diffuse adenomyosis, debulking surgery may leave significant adenomyosis remaining in the uterus.…”

Evaluation of perioperative morbidity associated with single and multiple myomectomy

“…As haemorrhage is the commonest complication, a number of strategies have been devised to reduce the intraoperative blood loss but there is very little evidence to suggest superior efficacy of one technique over another (Kunde et al 2005) and they are largely based on the operator choice. Although our observations suggest that use of a tourniquet does not reduce intraoperative blood loss, this was not a randomised trial and therefore it is quite likely that patients in whom the tourniquet was not used may have been at lower risk of bleeding and operator choice played a major role in adoption of the technique for reducing intraoperative blood loss.…”

Is Double Consent For Abdominal Myomectomy Still Necessary?

“…The cure for a uterine fibroid is total removal of the uterus 6 because of the high risk of recurrence which ranges from 2 -53% in 5 years with higher rates of recurrence following laparoscopic myomectomy 8,9,10. For a surgery that is therefore common, it's also expected that complications should be very common. Complications apart from anaesthetic complications include haemorrhage, damage to the adjoining structures like ovary, tubes, bladder, ureter and the rectum though the complication rates are comparable to hysterectomies if not less 13 . Over the years modifications and improvements in abdominal myomectomy techniques has made blood loss very minimal and have improved on the safety records of abdominal myomectomies.…”

“…Over the years modifications and improvements in abdominal myomectomy techniques has made blood loss very minimal and have improved on the safety records of abdominal myomectomies. Methods like use of tourniquet, vasopressin, misoprostol, gonadotrophin releasing analogues have drastically reduced the blood loss 2,13 Over the years, double consent for myomectomy has been the norm with inappropriate justifications. The reasons are more of historical or myths than scientific.…”

“…The reasons are more of historical or myths than scientific. In the early days of myomectomies since 1845 and up to early part of 20th century, mortality was as high as 40% compared to 9% in Hysterectomy 13 . However with improvement in skills, anaesthesia, blood transfusion and appropriate pre operative evaluations and preparations, good haemostasis, and better surgical techniques, mortality following…”