Utility of a minimal skin incision laparotomy technique for removing uterine leiomyomas at a regional core hospital: a retrospective study

Abstract

BackgroundWe present a minimal skin wound abdominal myomectomy performed in our hospital and attempt to identify the optimal range of this technique by considering the characteristics of target leiomyomas. In this procedure, we attempted to make the skin wound as small as possible, with a maximum length of approximately 5 cm.MethodsIn addition to introducing the minimal skin wound abdominal myomectomy, we retrospectively collected and analyzed the medical records of 76 patients treated with minimal skin wound abdominal myomectomy exclusively by the same physician at Maruyama Memorial General Hospital between January 2007 and December 2016. We statistically investigated relationships between ten factors, including body mass index; patient’s age; patient’s parity; administration of gonadotropin-releasing hormone analogue; presence of anemia; the uterine leiomyomas’ number, size, weight, and location; operation time; and blood loss.ResultsFirst, we introduce a case in which we performed minimal skin wound abdominal myomectomy for a 36-year-old Japanese patient with a large leiomyoma (10 cm in diameter). Then, we assessed the impacts of patient characteristics and leiomyoma characteristics on operation time and blood loss for this surgical method. In a multivariate analysis, only the number of resected leiomyomas significantly affected massive bleeding. Other factors showed no difference on operation time and the amount of blood loss.ConclusionsMinimal skin wound abdominal myomectomy is safe and effective for use in many patients, because only the number of leiomyomas affects the amount of blood loss. No other factor affected operation time. We suggest the possibility that the expanded use of minimal skin wound abdominal myomectomy may reduce the number of patients waiting for long periods to undergo laparoscopic surgery and may optimize the use of medical resources in rural areas.

Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study

“…Since we could only perform vNOTES-H in our hospital for patients with resected uterine weights less than approximately 250 g, we adopted this cut-off value, namely, 210 g, as a heavy uterus in this study by referring to the average and standard deviation of the uterine weight of all 111 patients. The criteria for “Advanced age”, “High BMI” and “Large leiomyoma” were determined based on past reports [16] , [17] , [18] , [19] . A “High BMI” was defined according to the definition of obesity of the Japan Society for the Study of Obesity.…”

Laparoscopy assisted minilaparotomy (LA-MLT) for big fibroids.

“…In their study the mean length of incision was 5.9 ± 0.44 cm in lap assisted minilaparotomy and 7.0 ± 0.08 cm for minilaparotomy. In a Japanese study by Sugiyama et al 9 the maximal length of incision was 5cm and the surgery was performed without assistance of laparoscopy. Mean size of largest fibroid in their study was 7.5 ± 2.7cm, suggesting that large fiborids are possible to be removed through minilaparotomy with an incision as small as 5cm and we can further assume that when laparoscopically assisted, the size of incision may still be even shorter.…”