Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma

Abstract

Objective: To study clinical outcomes for different uterine wall incision directions, comparing vertical incision and transverse incision in laparoscopic myomectomy of the intramural myoma.Methods: Laparoscopic myomectomies were performed on 50 women with intramural myomas. Using a table of random numbers, they were randomly divided into a vertical incision group (25 women) and a transverse incision group (25 women) according to the direction of incisions in the uterine wall. The numbers of enucleated myoma, operation duration, amount of bleeding, and numbers of sutures were compared. The Mann-Whitney U-test was used for analysis.Results: For the transverse incision group, the amount of bleeding (137.6 ± 88.1 mL) was a significantly lower value (P = 0.0426) than for the vertical incision group (235.8 ± 169.4 mL). In addition, in cases where the maximum myoma nucleus diameter was 7 cm or larger, operation duration (129.0 ± 32.5 min) and amount of bleeding (158.9 ± 87.1 mL) showed significantly lower values (P = 0.0067 and P = 0.0002, respectively) for the transverse incision group than did operation duration (362.3 ± 147.3 min) and amount of bleeding (362.3 ± 147.3 mL) for the vertical incision group. Conclusion:Transverse incision of the uterine wall is useful to reduce the amount of bleeding in the laparoscopic myomectomy of the intramural myoma. Transverse incision also shortens operation duration in cases where the myoma nuclei are large. (Reprod Med Biol 2004; 3: 33-37)

Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled Trial

“…This decline was more evident in large myomas (> 7 cm in diameter); with an estimated blood loss 158.9 ± 87.1 mL in transverse incisions, compared to 362.3 ± 147.3 mL in longitudinal incisions. Whereas no statistically signi cant differences were found between both incisions in smaller myomas (< 7 cm) [12] . This seems logic, as the traumatic effect becomes more evident with the extension of the longitudinal incision causing more damage to the traversing vessels; in contrast to the extension of the transverse incision that runs almost parallel to the vessels.…”

Blood Loss from Transverse Versus Longitudinal Uterine Incision in Abdominal Myomectomy: A Randomized Controlled Trial

“…Whereas no statistically signi cant differences were found between either incisions in smaller myoma (< 7 cm). [17] Logically, as the uterine incision is extended longitudinally, its traumatic effect is more pronounced, with the greater transection of traversing vessels; in contrast to the transection of vessels of the same axial plane with extension of the transverse incision. This effect might not be evident with smaller myomas.…”

“…This effect might not be evident with smaller myomas. However, validation by further studies is needed, as the proposed effect of myoma size in the study of Morita [17] is confounded by the large difference in operative time with myomas > 7 cm between longitudinal incision (165.4 min) and transverse incision (129 min), owing to the easier suturing technique of transverse incisions relative to the longitudinal ones.…”

“…A trial comparing the two types of incision in laparoscopic myomectomy was, however, found. This latter trial showed that the mean values for intraoperative EBL in transverse versus vertical uterine incision in laparoscopic myomectomy were 110.5 ± 81.7 ml and 136.4 ± 108.5 ml, respectively [17] . Therefore, transverse uterine incision would be assumed to reduce the mean intraoperative EBL by almost 18.9%.…”

Reproductive outcome after laparoscopic myomectomy for intramural myomas in infertile women with or without associated infertility factors

“…The myomas were removed by making a horizontal incision directly above the lesions with the hook‐type probe of an ultrasonic incision and coagulation system (Harmonic Scalpel: Ethicon Endo‐Surgery, Cincinnati, OH, USA). Hemostasis at the myomectomy sites was achieved with bipolar forceps 13 . All suturing was carried out intracorporeally.…”