Recurrence after robotic myomectomy: is it associated with use of GnRH agonist?

Sangha, Roopina; Katukuri, Vivek R.; Palmer, M.M.; Khangura, Raminder

doi:10.1007/s11701-016-0583-y

Cited by 8 publications

(7 citation statements)

References 17 publications

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“…No reply was received and these four studies were all excluded for further data extraction and analysis. Finally, 23 studies met our inclusion criteria and were used for data extraction [ 14 – 36 ]. Fourteen of the included studies reported on laparotomic myomectomies, eight studies on laparoscopic myomectomies and one study reported on both laparotomic and laparoscopic myomectomies [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Only the study of Sangha et al [ 36 ] did not report on conversion rate. In all other studies performing laparoscopic myomectomy (n = 430), no conversions to open procedures occurred.…”

Section: Resultsmentioning

confidence: 99%

“…The follow-up period in this trial was only eight to twelve weeks after primary surgery [ 22 ]. Rossetti et al [ 35 ] and Sangha et al [ 36 ] performed transvaginal ultrasound to assess recurrence rate till 40 months and 48 months respectively after primary surgery.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis

Milliano

Twisk²,

Ket

et al. 2017

PLoS ONE

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BackgroundMyomectomy has potential risks of complications. To reduce these risks, medical pre-treatment can be applied to reduce fibroid size and thereby potentially decrease intra-operative blood loss, the need for blood transfusion and emergency hysterectomy. The aim of this systematic review and meta-analysis is to study the effectiveness of medical pre-treatment with Gonadotropin-releasing hormone agonists (GnRHa) or ulipristal acetate prior to laparoscopic or laparotomic myomectomy on intra-operative and post-operative outcomes.MethodsWe performed an extensive search in Embase.com, Wiley/Cochrane Library and PubMed in accordance with the Prisma guidelines. All studies published as full papers in peer reviewed journals using GnRHa or ulipristal acetate as medical pre-treatment independent of route of administration or dosage before laparotomic or laparoscopic myomectomy were included. The primary outcome was duration of surgery. Secondary outcomes were duration of enucleation, blood loss, degree of difficulty of surgery, identification of cleavage planes, proportion of vertical incisions, conversion rate, frequency of blood transfusions, post-operative complications, duration of hospital stay, frequency of recurrence of fibroids, frequency of uterine adhesions, recovery time and quality of life. No language restrictions were applied. Meta-analysis were performed where possible.FindingsTwenty-three studies were included. In laparotomic myomectomy, pre-treatment with GnRHa decreases intra-operative blood loss with 97.39ml (95% CI -111.80 to -82.97) compared to no pre-treatment or placebo. Pre-treatment with GnRHa before laparoscopic myomectomies also shows a reduction in intra-operative blood loss by 23.03ml (95% CI -40.79 to -5.27) and in the frequency of blood transfusions (OR 0.17, 95% CI 0.05 to 0.55) compared to no pre-treatment.Only two retrospective cohort studies reported on pre-treatment with ulipristal acetate compared to no pre-treatment before laparoscopic myomectomy showing a statistically significant reduction in intra-operative blood loss, duration of surgery and frequency of blood transfusions after pre-treatment with ulipristal acetate.ConclusionAdministration of GnRHa prior to laparotomic myomectomy reduces blood loss and might decrease uterine adhesion formation. Pre-treatment with GnRHa before laparoscopic myomectomy reduces blood loss, the frequency of blood transfusions and might increase recurrence rate of fibroids, however it should be taken into account that some results are mainly based on cohort studies. Other pre-treatment agent ulipristal acetate has not been investigated sufficiently for relevant surgical outcomes.

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Section: Resultsmentioning

confidence: 99%

“…Only the study of Sangha et al [ 36 ] did not report on conversion rate. In all other studies performing laparoscopic myomectomy (n = 430), no conversions to open procedures occurred.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis

Milliano

Twisk²,

Ket

et al. 2017

PLoS ONE

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show abstract

“…In most of them, age, myoma size, and the number of myomas were suggested as the risk factors for fibroid recurrence (11)(12)(13)(14)(15). Other risk factors, such as preoperative GnRH therapy and postoperative pregnancy, were also pointed out as risk factors for fibroid recurrence in some studies (16,17).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Risk of Fibroid Recurrence After Laparoscopic Myomectomy and Its Associated Risk Factors

Asgari,

Pourhoseini,

Hosseini

et al. 2023

Shiraz E-Med J

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Background: Although laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma, there is no clear consensus regarding its rate of recurrence and associated risk factors. Objectives: This study aimed to investigate the recurrence rate of myoma and its risk factors after laparoscopic myomectomy. Methods: In a historical cohort study, 172 patients who underwent laparoscopic myomectomy and had a minimum follow-up of 2 years were included. Myoma recurrence was checked semiannually by ultrasound imaging. The demographic, clinical, surgical, sonographic, and laboratory indices of the patients were compared between the recurrent and nonrecurrent groups, both in logistic regression models. Results: The mean age of the patients was 35 ± 5.7 years (range: 18 - 47 years). Their mean follow-up time was 26.3 ± 4.2 months (range: 24 - 28). The lesion recurred in 25 (14.5%) out of 172 patients. In the univariate analysis, higher age (OR:1.111, P = 0.015), higher body mass index (OR: 1.124, P = 0.024), gonadotropin-releasing hormone (GnRH) therapy (OR = 3.83, P = 0.027), and more than 1 myoma (OR: 2.60, P = 0.032) were associated with myoma recurrence. In the multiple analysis, a higher body mass index (OR: 1.222, P = 0.003) was a significant risk factor for myoma recurrence. Conclusions: Laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma and can be used as a uterus-preserving surgical alternative in patients of reproductive age. A more radical surgical procedure might be used for patients with multiple risk factors, as revealed in the present study.

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“…The authors hypothesized that it is likely because of the extraction of small leiomyomas, which is less exhausting in manual removal than in the laparoscopic approach. The growth of residual myoma masses then results in newly diagnosed fibroids, which are considered recurrences [37] . Considering the better flexibility of robotic instruments, enucleation of small myomas should be more accessible, leading to lower recurrence.…”

Section: Fertility and Obstetrical Outcomes And Recurrencementioning

confidence: 99%

Current status on robotic assisted myomectomy

Kiss¹,

Svobodová²,

Karasek³

et al. 2021

MIS

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Uterine leiomyomas are common benign solid tumors of the uterus. While the presence of fibroids is rarely life threatening, they are associated with symptoms affecting quality of life and fertility. Myomectomy is a standard fertility-sparing surgery which should be considered for women suffering from fibroid-related symptoms who do not desire hysterectomy or any alternative treatment option. While open surgery is thought to be reserved for large and numerous myomas, mini-invasive methods as laparoscopy and robot-assisted surgery have evolved in the hands of experienced surgeons to also deal with these more complex cases. Robotic myomectomy has its advantages in lower blood loss, fewer complications, and shorter hospital stay over open surgery, whereas the comparison outcomes with laparoscopic myomectomy are still uncertain. Advantages of the wristed instruments, three-dimensional vision along with the incorporation of correct surgical techniques could emphasize the benefits of the robotic assisted approach in large and numerous myoma cases. Careful and detailed assessment should precede the surgery to recognize risks and steps to reduce operation time, which tends to be the most presented drawback of robotic myomectomy. As the tendency of robot-assisted surgeries is growing, many authors share their experience or publish comparison studies with other surgical methods. Our article describes the current status concerning robotic myomectomy, reviewing publications from the past five years (2016-2021).

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Recurrence after robotic myomectomy: is it associated with use of GnRH agonist?

Cited by 8 publications

References 17 publications

Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis

Pre-treatment with GnRHa or ulipristal acetate prior to laparoscopic and laparotomic myomectomy: A systematic review and meta-analysis

Short-Term Risk of Fibroid Recurrence After Laparoscopic Myomectomy and Its Associated Risk Factors

Current status on robotic assisted myomectomy

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