Search

Introduction: Laparoscopic myomectomy is a commonly performed operation with fast recovery and excellent results. However, haemorrhagic nature of the operation mandates us to use variety of vasoconstrictive and uterotonic agents. Amongst which, one of them is vasopressin. It is a synthetic antidiuretic hormone analogue which has been in common use as a vasoconstrictive agent in various surgical procedures including laparoscopic myomectomy. Methods: A meta‑analysis of randomised controlled trials published from 2013 to 2023 (10 years) comparing the use of vasopressin against other drug or placebo or different doses of vasopressin was performed. The outcome measures were intraoperative blood loss, need for blood transfusion, difference in the haemoglobin (Hb) and haematocrit (Hct). Results: We identified 176 articles through the study search, amongst which 12 articles were included for the meta‑analysis. There was a significant heterogeneity in the studies with moderate risk of bias in eight studies and low risk of bias in four studies. Compared to placebo, vasopressin showed significantly lower odds need of blood transfusion (odds ratio [OR] 0.28, 95% confidence interval [CI]: 0.13–0.61, P = 0.002) and significantly lower pre–post fall in Hb (OR −3.12, 95% CI: −4.63–−1.60, P < 0.0001). However, there was no statistically significant difference in intraoperative blood loss (OR −0.56 (95% CI: −2.04–0.92, P = 0.46) and pre–post fall in Hct (OR −0.94, 95% CI: −1.96–0.07, P > 0.05). Compared to other drug (epinephrine, misoprostol and octreotide acetate), vasopressin showed no significant superiority in controlling blood loss (P > 0.05). Even the two doses of vasopressin (dilute vs. concentrated) showed no statistically significant difference between surgical blood loss and need for blood transfusion (P > 0.05). Conclusion: Vasopressin is an efficacious drug to be used for controlling blood loss, decreasing blood transfusion requirement and maintaining Hb and Hct during laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Background: Misoprostol is a synthetic version of prostaglandin E1, unlike its naturally occurring counterpart. Prostaglandins enhance the contractions of the myometrium, resulting in a decrease in bleeding from the myometrium. Objective: To assess the effect of preoperative sublingual misoprostol versus a placebo on intraoperative blood loss during abdominal myomectomy. Patients and methods: This case control study conducted on 100 patients at Damanhour Medical National Institute from October 2023 until March 2024. Results: There was no discernible disparity in the use of Vasopressin among laparoscopic & open myomectomy (p-value = 0.15) or Tranexamic Acid (pvalue = 0.39). In terms of postoperative complications, in the misoprostol group, 8% of patients had nausea, 4% had vomiting, and 8% had shivering, while in the control group, 4% of patients had nausea, 6% of patients had vomiting, and 4% of patients had shivering. There was no discernible disparity in complications between the groups. Conclusions: Our study concluded that there was a significant disparity in blood loss during surgery amongst the two groups. Our findings also indicate that administering sublingual misoprostol before surgery is an easy, easily implemented, and comfortable approach to decreasing intraoperative blood loss throughout abdominal myomectomy. [ABSTRACT FROM AUTHOR]

Meigs syndrome is a classic triad of ascites, pleural effusions, and an ovarian fibroma with resolution following excision. Pseudo‐Meigs syndrome presents similarly but is caused by a pelvic mass other than an ovarian fibroma, such as a fibroid. We present a case report of a 33‐year‐old gravida 2 para 0‐0‐1‐0 woman with a massive, pedunculated fibroid who developed rapid onset of ascites and edema beginning at 5 weeks of gestation. Malignant, cardiac, renal, hepatic, and rheumatologic causes were ruled out. Her symptoms resolved following myomectomy and delivery via cesarean. Pseudo‐Meigs syndrome was suspected. Pseudo‐Meigs syndrome is a diagnosis of exclusion and requires surgical management for resolution. Pregnancy may be an inciting factor. Myomectomy may be done safely at the time of cesarean. Synopsis: Pseudo‐Meigs syndrome consists of ascites, pleural effusions, and a benign pelvic mass and resolves with surgical excision; it may be exacerbated in pregnancy. [ABSTRACT FROM AUTHOR]

[Display omitted] • FTUV ratio is the proportion of uterine volume occupied by intramural fibroids. • Easy-to-measure ultrasound tool in pre-surgical evaluation of intramural fibroids. • Improved pre-surgical counseling of patients who desire to conceive post-myomectomy. • FTUV ratio as potential predictor of likelihood to achieve pregnancy after surgery. To explore the utility of the total fibroids-to-uterine volume (FTUV) ratio as a simple, preoperative tool to assist in counseling patients seeking pregnancy who are undergoing myomectomy for intramural (IM) fibroids. This is an historical cohort study on reproductive-aged patients seeking pregnancy who underwent laparotomic myomectomy for intramural fibroids from January 2017 to December 2021. Only G3 to G5 fibroids, according to the 2011 International Federation of Gynecology and Obstetrics (FIGO) classification, were included. Pre-operative transvaginal ultrasound (TVUS) was performed to measure the volume of intramural myomas (diameter 1 *diameter 2 *diameter 3 *0.52) and to calculate their total volume. The total fibroids-to-uterine volume (FTUV) ratio was calculated as the proportion of the uterine volume occupied by the sum of IM fibroids volumes. A total of 166 women with pre-surgical TVUS evaluation of IM fibroids were included, with a mean age of 36.22 ± 5.15 years. The FTUV ratio was identified as a positive predictor of clinical pregnancy after surgery (adjOR, 1.04; 95 % CI, 1.02–1.06; p = 0.0001), whereas age showed a negative association (adjOR, 0.90; 95 % CI, 0.83–0.98; p = 0.012). Endometrial cavity distortion prior to surgery was also positively associated with pregnancy post-surgery (adjOR, 3.50; 95 % CI, 1.51–8.08; p = 0.003). Consistent results were found for live births, with the FTUV ratio being a significant positive predictor of live birth after surgery (adjOR, 1.03; 95 % CI, 1.01–1.05; p = 0.001) and age showing a negative association (adjOR, 0.88; 95 % CI, 0.80–0.96; p = 0.004). Parity prior to surgery also positively impacted live birth post-surgery (adjOR, 2.65; 95 % CI, 1.30–5.40; p = 0.007). An FTUV ratio threshold of 53.39 % accurately predicted clinical pregnancy in 68.46 % of cases (sensitivity of 71.70 % and specificity of 66.67 %). For live births, a higher FTUV ratio threshold of 59.21 % predicted outcomes accurately in 69.13 % of cases (sensitivity of 65.85 % and specificity of 70.37 %). The use of the FTUV ratio in pre-operative ultrasound evaluation of IM fibroids may improve counseling for patients desiring to conceive after myomectomy. By providing a personalized assessment of the amount of myometrial volume occupied by fibroids, the FTUV ratio can help predict fertility outcomes after surgery, enabling better-informed decisions and treatment planning. [ABSTRACT FROM AUTHOR]

Molecular status of uterine leiomyomas has been shown to affect both tumor characteristics and treatment response. Mutations in mediator complex subunit 12 (MED12) , the most prevalent alterations in leiomyomas, are associated with tumor size and number of leiomyomas. Myomectomy can be performed by laparoscopy or by open abdominal surgery, depending on the size and number of leiomyomas removed. The aim of this study was to examine the association between MED12 mutation status and surgical approach of myomectomy. We also evaluated myomectomy patients' quality of life after laparoscopic or abdominal surgery and according to the MED12 mutation status. The prospective cohort study included 104 women who underwent laparoscopic or abdominal myomectomy at the Helsinki University Hospital during 2015–2019. Patients filled in the validated Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire before the operation and 6 and 12 months after the operation. Medical records were reviewed to collect clinical data. Leiomyoma tissue samples were collected and screened for MED12 mutations. Patients undergoing abdominal myomectomy had larger and more numerous leiomyomas compared to patients with laparoscopic myomectomy (10 cm vs 7.4 cm, p < 0.001 and 3 vs 1 leiomyomas, p < 0.001, respectively). A mean change of over 20 points was seen in UFS-QOL scores at 6 months after both laparoscopic and abdominal myomectomy (p < 0.001). MED12 mutations were detected in 178/242 (74 %) of leiomyomas. Of the patients, 45/97 (46 %) had only MED12 positive leiomyomas, while 39/97 (40 %) had only MED12 wild type leiomyomas. The number of leiomyomas removed was higher among patients with MED12 positive leiomyomas than in patients with MED12 wild type tumors (p < 0.001). Laparoscopic approach was equally common in both groups (62 % and 64 %), and there was no statistically significant difference in the UFS-QOL scores. Both laparoscopic and abdominal myomectomy significantly improved the quality of life. While MED12 mutations were related with multiple leiomyomas and therefore potentially generated a greater leiomyoma burden, they were not associated with the surgical approach. Pre- and postoperative quality of life was comparable between patients regardless of MED12 status. [ABSTRACT FROM AUTHOR]

• Uterine smooth muscle tumors of uncertain malignant potential are rare tumors. • Their behavious is not as aggressive as uterine sarcomas. • If desiring fertility , myomectomy can be considered as an option. • Continued follow up is necessary in such patients. • More information of outcomes with conservative surgery will be vaulauble ofr treating clinicians. The Primary Objective of this study was to analyse reproductive outcomes in patients with STUMP (Smooth Muscle Tumour of Uncertain Potential) or ALM (Atypical Leiomyoma) who underwent fertility-preserving surgeries. Secondary Objectives were to analyse long-term prognosis for these patients and to study the basic demographic and pathological characteristics of patients with STUMP or ALM. This retrospective study was conducted at Amrita Institute of Medical Sciences. Cases of STUMP and ALM were retrieved from the hospital medical database between June 2014 and December 2022. Demographic parameters, clinical presentations, pathological features and clinical outcomes were analysed. Categorical variables were expressed in numbers and percentages. Normal distribution data were presented as mean while non-normal distribution was expressed as median and range. Thirty-eight patients were included in the study with a diagnosis of STUMP or ALM in postoperative histology. Seven patients (18.4%) were nulliparous. Myomectomy was performed in 9 (23.6%), while hysterectomy was done in 29 patients (76.3%). Fertility-preserving surgeries were performed on six patients (15.7%). Of these six patients, 4(66.6%) conceived spontaneously and had successful pregnancies. Recurrences were found in 3 patients (7.8%) out of which one had undergone fertility-sparing surgery. All the patients with recurrences had previous history of myomectomies. Morcellation was reportedly done in 2 of these three patients. Good reproductive outcomes have been demonstrated in patients diagnosed with STUMP or ALM and desiring fertility. However, these patients should be kept under follow-up care as they are prone for recurrences. Patients who have undergone morcellation mayhave an increased chance of recurrence. [ABSTRACT FROM AUTHOR]

The prevalence of fibroids during reproductive age is 20–25%. The presence of fibroids during pregnancy can impact perinatal outcomes. Objective: To determine whether fibroids affect perinatal outcomes and whether women who undergo fibroid surgery before pregnancy have better perinatal outcomes than those who have fibroids during pregnancy. The study also analyzes the optimal time interval between myomectomy and pregnancy and the characteristics of fibroids during pregnancy that affect perinatal outcomes. In both groups, fibroids' size, number, and location were analyzed to determine their influence on perinatal outcomes. The perinatal outcome is determined by gestational age, birth weight, Apgar score, intrauterine growth retardation, placental complications, and delivery method. Methods: A study was conducted on the perinatal outcomes of 338 women who had uterine fibroids during pregnancy and those who had undergone fibroid surgery before pregnancy. The medical records of women who gave birth at a tertiary university hospital were analyzed in this retrospective study. Results: Women with submucosal fibroids have a lower gestational age of delivery (P = 0.0371), and those who operated on a higher number of fibroids before pregnancy had newborns with lower birth weights (P < 0.0001). Submucosal fibroids during pregnancy increase the chances of cesarean delivery (P = 0.0354). 14% of newborns have an Apgar score of less than seven within the first minute of birth in fibroids larger than 7 cm (P < 0.0001). Conclusion: There is a statistically significant difference in the perinatal outcome of newborns depending on the number, size and placement of uterine fibroids in both observed groups. [ABSTRACT FROM AUTHOR]

To investigate perioperative outcomes of minimally invasive higher order myomectomy as defined by removal of 10 or more fibroids. A retrospective cohort study between January 2018 and December 2022. A tertiary academic medical center. Women who underwent minimally invasive myomectomy via laparoscopic or robotic approach. Surgical intervention in the form of minimally invasive myomectomy. A total of 735 women met inclusion criteria of whom 578 had fewer than 10 fibroids removed, and 157 patients had 10 or more removed (average number of fibroids removed 3.8 vs 14.7, p <.001; specimen's weight 317.4 g vs 371.0 g, p =.07). Body mass index was similar in both groups (p =.66) and patients with higher order myomectomy were more likely to have a history of myomectomy (12.0% vs 26.8%, p <.001). The average estimated blood loss (EBL) was 246 mL vs 470 mL in each group (p <.001). There were no significant differences in packed red blood cell transfusion (1.0% vs 0.6%, p =.65), conversion to laparotomy (0.5% vs 0.6%, p =.86), or complications including visceral injury, wound complication, venous thromboembolism, ileus, or readmission (5.9% vs 4.5%, p =.49). The hospital length of stay was similar in both groups (0.5 days vs 0.5 days, p =.63). On linear regression analysis, after adjusting for specimen's weight, operative time, and history of myomectomy, EBL remained significantly higher in patients with 10 or more fibroids removed (p =.02). EBL is increased in higher order myomectomy; however, blood transfusions, conversion to laparotomy, complication rates, and length of hospital stay did not differ compared with patients with fewer than 10 fibroids removed, highlighting the feasibility of minimally invasive higher order myomectomy. [ABSTRACT FROM AUTHOR]

This study aims to objectively assess the effect of three surgical approaches for posterior uterine fibroid resection: transumbilical laparoendoscopic single-site surgery (LESS), vaginal natural orifice transluminal endoscopic surgery (vNOTES) in prone position (vNOTES-P), and vNOTES in the lithotomy position (vNOTES-L). A retrospective analysis was conducted on data pertaining to all patients who underwent vNOTES and LESS for single posterior fibroids at our institution from January 2023 to July 2023. Patients were categorized into three groups based on the surgical approach: vNOTES-P group (n = 30), vNOTES-L group (n = 17), and LESS group (n = 32). Comparative analysis was performed on the demographic characteristics and perioperative outcomes among the three groups of patients. All 79 patients underwent surgery without the need for conversion to laparotomy. There were no statistically significant differences among the LESS group, vNOTES-P group, and vNOTES-L group in terms of operative time, intraoperative blood loss, and perioperative complication rates. In the vNOTES-L group, two patients required conversion to LESS during surgery. Patients had faster return of bowel function (less time to flatus) in the vNOTES group compared to the LESS group (P < 0.05). However, three cases of postoperative infection occurred in the vNOTES group, while none were reported in the LESS group. Compared to LESS, vNOTES demonstrates significant advantages in alleviating postoperative pain, shortening time to passage of flatus, speeding recovery and enhancing cosmetic outcomes. Particularly, vNOTES-P for posterior uterine fibroid resection, as an emerging surgical approach, offers certain advantages in facilitating surgical maneuverability and reducing operative time, rendering it more suitable for posterior uterine fibroid resection. [ABSTRACT FROM AUTHOR]

Objective: Laparoendoscopic single-site myomectomy (LESS-M) is widely applied for the treatment of uterine leiomyoma. The purposes of this study were to investigate differences in hidden blood loss between LESS-M and conventional laparoscopic myomectomy (CLM) during treatment of uterine leiomyoma and to identify the associated risk factors. Design: This is a retrospective study. Participants: The participants of this study were patients who underwent laparoscopic myomectomy (114 and 156 for LESS-M and CLM, respectively) between July 1, 2019, and October 10, 2020, at the Second Affiliated Hospital of Wenzhou Medical University. Setting: The study was conducted at the Second Affiliated Hospital of Wenzhou Medical University. Methods: We enrolled a total of 114 and 156 patients who were treated with LESS-M and CLM, respectively, between July 1, 2019, and October 10, 2020. We collected clinical data, then applied the Nadler and Gross formula and multiple linear regression analysis to calculate the HBL and identify the associated risk factors, respectively. Results: Patients in the LESS-M group had a VBL of 115.4 ± 180.6 mL and an HBL of 364.3 ± 252.6 mL, accounting for 74.4 ± 22.4% of true TBL. On the other hand, patients in the CLM group had VBL of 187.9 ± 198.5 mL, and HBL of 306.8 ± 304.7 mL, accounting for 58.9 ± 30.2% of true TBL. HBL was significantly higher in the LESS-M than the CLM group (p = 0.000). Limitations: This study was the small sample size used. Conclusions: HBL accounted for a significant percentage of TBL in laparoscopic myomectomy, especially in patients treated with LESS-M. Paying attention to perioperative blood changes coupled with fully understanding HBL might promote postoperative recovery of patients. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Studies on parasitic myomas after laparoscopic morcellation are mainly limited to case reports, and the incidence and risk factors have not yet been well‐understood. We aimed to clarify the actual incidence and risk factors of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation by reviewing cases with subsequent laparoscopic surgery.This retrospective study included 87 patients who had laparoscopic myomectomy using uncontained power morcellation, followed by subsequent second laparoscopic surgery for gynecological disease between 2008 and 2021. First, the incidence and characteristics of parasitic myomas detected at the second laparoscopic surgery were reviewed. Second, patients were stratified according to the presence of parasitic myoma (PM+ and PM− groups), and risk factors were analyzed by comparing the background, intraoperative findings, and clinical course after laparoscopic myomectomy.Of the 87 patients, parasitic myomas were detected in 16 (18.4%). Twelve patients (75.0%) were asymptomatic and diagnosed incidentally during surgery. Two patients presented with acute abdomen requiring emergency surgery. Comparing the PM+ and PM− groups, the total weight of the enucleated myomas and the diameter of the largest myoma at the initial laparoscopic myomectomy were significantly greater in the PM+ group. Other factors, including age and number of enucleated myomas did not differ between the groups.The actual incidence of parasitic myoma after laparoscopic myomectomy using uncontained power morcellation is higher than that previously reported. In laparoscopic power morcellation, large myomas increase the risk of developing parasitic myoma, and a containment bag system is expected to minimize this complication. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion Our study aimed to evaluate the effect of superior hypogastric nerve plexus (SHNP) block in postoperative pain management in the first 24 h after minimally invasive gynecological (MIG) surgeries.We conducted a double‐blinded, randomized controlled trial in the Department of Obstetrics and Gynecology at a tertiary care centre from May 1, 2023 to September 30, 2023 in women undergoing major MIG surgeries. At the completion of the surgery, women were randomized to the intervention group who received SHNP block with ropivacaine 10 mL (0.75%) before port removal, whereas no intervention was taken in the control group. The extubation time was noted, and the pain score was assessed after 1, 2, 6, 12, and 24 h of extubation in the postoperative period using the visual analog scale (VAS). Statistical analysis was done, with a significance level of 0.05, to test the differences between the two groups.A total of 64 patients were randomly allocated to intervention and control groups. The median pain score was lower at 1 and 2 h post‐extubation and comparable between the two groups at 6, 12, and 24 h. The surrogate markers that is need for additional analgesia and duration of stay did not differ significantly in the two groups, with P‐values of 0.08 and 0.943, respectively.Although the SHNP group experienced considerably lower immediate postoperative pain levels in the initial hours following extubation, the impact of this benefit remains uncertain in the longer postoperative period. The effectiveness of this modality for pain control needs further study, particularly at later postoperative hours. [ABSTRACT FROM AUTHOR]

Gynecologic surgery with minimally invasive method using robotic or laparoscopic techniques has gained popularity for reducing perioperative discomfort and length of hospital stay. However, the debate over postoperative pain superiority between traditional laparoscopy and robotic surgery persist. This study compared the postoperative pain of patients within 24 h of robotic (RM) and laparoscopic myomectomy (LM). This retrospective cohort study included 24 and 53 patients who underwent RM and LM, respectively, between January 2019 and July 2023. The primary outcomes were the postoperative pain levels of patients within 24 h and the use and dosage of postoperative analgesia. Additional perioperative analgesia, including long-acting non-steroidal anti-inflammatory drugs (Dynastat) and abdominal nerve block, was also recorded. The secondary outcomes were blood loss and hospitalization duration. The patient characteristics were similar between the groups. Factors that could potentially increase pain, such as the number of ports (p < 0.0001), additional procedures (p = 0.0195), operative time (p < 0.0001), number of myomas (p = 0.0057), and the largest myoma size (p = 0.0086), were significantly higher in the RM group than in the LM group. However, there were no significantly different in the postoperative visual analog scale pain scores, use and dosage of ketorolac and opioid, and use of Dynastat and nerve block between the groups. Hospitalization duration and intraoperative blood loss were similar between the groups. RM and LM offer comparable postoperative pain outcomes, emphasizing the importance of patient-specific factors in decision-making regarding myomectomy techniques. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Evidence about intra‐ and postoperative complication rates related to transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign gynecological conditions is still limited. We report and analyze data from a large cohort of patients operated in a single institution during 3.5 years.To evaluate the safety and feasibility of vNOTES for benign gynecological indications, we performed a single‐center observational study reporting and analyzing perioperative outcomes of 550 consecutive patients operated between 2020 and 2024.Of the 550 included patients, 365 (66.4%) underwent a vNOTES hysterectomy, 167 (30.4%) a procedure limited to the adnexa, and 18 (3.3%) other interventions, including myomectomy, pelvic adhesiolysis, post‐hysterectomy pelvic hematoma drainage, pelvic organ prolapse repair, and appendectomy. The mean age was 49.4 ± 12.2 years, and the mean BMI was 26.2 ± 5.8 kg/m2. The total complication rate was 6.5% (36 cases), of which 2.7% (15 cases) were intraoperative complications and 4.0% (22 cases) were postoperative complications. Patients presented postoperative complications classified as Clavien–Dindo (CD) grade I in 4 cases (0.7%), grade II in 10 cases (1.8%), and grade III in 8 cases (1.5%). We observed no CD grade IV and V complications. Three patients (0.5%) were rehospitalized for postoperative complications management. The conversion rate was 1.6%, with nine cases of conversion to conventional laparoscopy and none to laparotomy.The application of vNOTES appears safe and feasible for most benign gynecological surgeries. Our study focused on surgical complications and demonstrated a profile similar to those reported in previous studies. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between serum tumor specific growth factor (TSGF), monocyte chemoattractant protein-1 (MCP-1), angiopoietin-2 (Ang-2) and recurrence after laparoscopic myomectomy (LM) and the construction of a nomograph prediction model. Methods: 213 uterine fibroids patients who were undergoing LM surgery admitted to our hospital from June 2018 to June 2020 were selected as study subjects. The serum levels of TSGF, MCP-1 and Ang-2 were detected in all patients. After 3 years of follow-up, patients were divided into recurrence group and non-recurrence group according to whether patients had recurred 3 years after operation, the serum levels of TSGF, MCP-1 and Ang-2 were compared between two groups. The risk factors of recurrence after LM in uterine fibroids patients were analyzed by univariate and multivariate Logistic regression analysis, and a nomograph prediction model for postoperative recurrence risk was constructed according to the risk factors. The predictive efficacy of serum MCP-1, TSGF and Ang-2 on the recurrence of LM in uterine fibroids patients were analyzed by receiver operating characteristic (ROC) curve. Results: 213 uterine fibroids patients were followed up for 3 years, and 8 patients were lost to follow-up, there were 37 cases of recurrence in 205 uterine fibroids patients 3 years after LM, and the recurrence rate was 18.05% (37/205). The serum levels of Ang-2, MCP-1 and TSGF in non-recurrence group were lower than those in recurrence group, and the differences were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that, postoperative residual myoma, elevated serum TSGF, age≥35 years, elevated MCP-1, multiple fibroids and elevated Ang-2 were independent risk factors for recurrence after LM in uterine fibroids patients(P<0.05). ROC analysis showed that, the area under the curve (AUC) of serum TSGF, MCP-1, Ang-2 and nomograph prediction model was 0.873 (95%CI: 0.801~0.944), 0.721 (95%CI: 0.624~0.817), 0.803 (95%CI: 0.722~0.885), 0.986 (95%CI: 0.973~0.998). Internal validation (B=1000) showed that, the C-index was 0.972, suggesting that the nomograph prediction model had a good predictive ability. The decision analysis shows that, the threshold probability of the model was 0.01~0.95, and the net return rate was>0, which was higher than the two invalid lines. Conclusion: The increase of serum TSGF, MCP-1 and Ang-2 levels can lead to the recurrence of LM in uterine fibroids patients. Age≥35 years old, multiple fibroids, postoperative residual myoma, elevated serum TSGF, elevated MCP-1 and elevated Ang-2 are independent risk factors for recurrence after LM in uterine fibroids patients. The nomograph prediction model base on independent risk factors has a good predictive value for the recurrence of LM in uterine fibroids patients. [ABSTRACT FROM AUTHOR]

Background: Myomectomy is the preferred treatment for women with uterine fibroids and fertility requirements. There are three modalities are used in clinical practice for myomectomy: abdominal myomectomy (AM), laparoscopic myomectomy (LM), and robot‐assisted laparoscopic myomectomy (RLM). Objectives: To compare the perioperative and postoperative outcomes of RLM, AM, and LM. Search Strategy: We searched PubMed, Web of Science, Embase, and Clinical Trials for relevant literature published between January 2000 and January 2023. Selection Criteria: We included all studies reporting peri‐ and postoperative outcomes of myomectomy in patients with uterine myomas. Surgical treatments were classified as RLM, LM, or AM. Data Collection and Analysis: Two or more authors selected studies independently, assessed risk of bias, and extracted data. We derived mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CIs) for each outcome, subgrouping trials by the patient characteristics and myoma characteristics. We used the I2 statistic to quantify heterogeneity and the random‐effects model for meta‐analysis when appropriate. We used the funnel plot to assess the publication bias. Main Results: A total of 32 studies with 6357 patients were included, of which 1982 women had undergone RLM. The operating time was significantly longer (MD = 43.58, 95% confidence interval [CI]: 25.22–61.93, P < 0.001), and the incidence of cesarean section after myomectomy was significantly lower (OR = 0.27, 95% CI: 0.10–0.78, P = 0.02) in RLM than in LM. Compared with AM, the operation time, blood loss, blood transfusion rate, complication rate, total cost, length of hospital stay, and pregnancy rate of patients with RLM were significantly different. Conclusions: The safety and effectiveness of RLM are superior to those of AM but inferior to those of LM. Synopsis: The safety and effectiveness of robot‐assisted laparoscopic myomectomy are superior to those of abdominal myomectomy but inferior to those of laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

To evaluate the impact of high-intensity focused ultrasound (HIFU) ablation on the histopathological features of locally recurrent fibroids tissue. Patients who underwent transabdominal hysterectomy or myomectomy for uterine fibroids from January 1, 2021 to July 1, 2023 at a teaching hospital in China were enrolled in this prospective study. The patients who underwent surgery for local recurrence of uterine fibroids after HIFU ablation were categorized as the HIFU group, and patients who had not undergone HIFU ablation for uterine fibroids were the control group. Hematoxylin-eosin (HE) staining, Masson staining, and immunohistochemical staining were performed to analyze the counts of smooth muscle cells (SMCs), collagen content, microvascular count, and the expression levels of estrogen receptor (ER) and progesterone receptor (PR) in the fibroid tissue specimens. The mean SMC counts in the HIFU and control groups were 337.68/field and 328.52/field respectively. The mean collagen content in the HIFU group and control group were 46.06% and 41.69% respectively. The mean microvessel counts in the HIFU group and control group were 13.66/field and 14.08/field respectively. The mean ER scores in the HIFU and control groups were 6.9 and 7.47 respectively, and the mean PR scores were 7.3 and 7.56 respectively. Overall, there were no significant differences in the SMC counts, collagen content, microvascular counts, and the ER and PR expression levels between the HIFU group and control group (p > 0.05). HIFU ablation has no effect on the pathological characteristics of local recurrent fibroid tissue, and is an ideal non-invasive treatment option. [ABSTRACT FROM AUTHOR]

Background and Objectives: The use of a bipolar resectoscope has become popular due to the lower risk of hyponatremia. However, gynecologists might overlook the risk of water intoxication. Water intoxication is associated with the infusion of distending fluid. We were interested in the prediction of the infused distending fluid volume in the era of bipolar hysteroscopy. Thus, the aim of this study was to identify the predictors of the infused distending fluid volume for hysteroscopic myomectomy. Materials and Methods: All consecutive women who underwent monopolar (n = 45) or bipolar (n = 137) hysteroscopic myomectomy were reviewed. Results: Myoma diameter (cm, coefficient = 680 mL, 95% confidence interval (CI) = 334–1025 mL, p <0.001) and bipolar hysteroscopy (coefficient = 1629 mL, 95% CI = 507–2752 mL, p = 0.005) were independent predictors of infused distending fluid volume. A myoma diameter ≥4.0 cm was the optimal cutoff value to predict the presence of >5000 mL of infused distending fluid. One woman in the bipolar group developed life-threatening water intoxication. Conclusions: Myoma diameter is associated with an increase in infused distending fluid volume, especially for myomas ≥4 cm. Meticulous monitoring of the infused distension fluid volume is still crucial to avoid fluid overload during bipolar hysteroscopic myomectomy. [ABSTRACT FROM AUTHOR]

Background: Angioleiomyoma, a benign tumour composed of smooth muscle cells and thick-walled vessels, is expected to be very rare in the female genital tract. This study aimed to describe the clinicopathological features and treatment outcomes of angioleiomyoma in the female genital tract. Methods: We retrospectively reviewed 89 women with angioleiomyoma in the genital tract who were treated at Third Xiangya Hospital of Central South University between July 2008 and October 2023. Symptom remission rate was the primary outcome of the study. Results: Angioleiomyomas accounted for 0.6% of leiomyomas of the female genital tract. The average age of the 89 women was 41.8 ± 8.7 years. Seventy women (78.7%) had a history of uterine surgery, of whom two patients had removed uterine angioleiomyoma by laparoscopic myomectomy. The angioleiomyomas of 61 (68.5%) women were located in the uterine corpus, 17 (19.1%) in the broad ligament, 10 (11.2%) in the cervix and only 1 (1.1%) in the vagina. Abnormal uterine bleeding was the main clinical manifestation of angioleiomyomas located in the uterine corpus or cervix, whereas the main clinical manifestation of angioleiomyomas in the broad ligaments was pelvic mass. Of the 89 women, 59 underwent surgery to preserve the uterus, and 30 underwent total hysterectomy or subtotal hysterectomy. The intraoperative blood loss was more than 500 ml (700–4,500 ml) in six women. The symptom remission rate was 100% after surgery. Among the 59 women with preserved uterus, 8 showed multiple uterine leiomyomas during follow-up, but it was difficult to determine whether they were angioleiomyomas. Angioleiomyomas recurred in one women who underwent total hysterectomy. Conclusion: Angioleiomyoma is rare in the female reproductive tract, and patients may present with diverse symptoms, which are related to the location of the tumour. Hysterectomy and myomectomy are both effective treatment methods, but the risk of intraoperative bleeding should be recognised for multiple lesions and those with large diameters. Relapse may occur in some patients. [ABSTRACT FROM AUTHOR]

To investigate the safety and effectiveness of transumbilical paring and retrieving techniques (TPRT) in conventional laparoscopic surgery (CLS). From July 2020 to October 2021, TPRT, based on transumbilical laparoendoscopic single-site surgery (TULESS), was applied to 111 cases of conventional laparoscopic myomectomy. The operation procedures included routine conventional laparoscopic myomectomy and uterine suture, placement of the endoscopic bag, tumor bagging, umbilical incision, paring and retrieving the tumor, and repairing the umbilical incision. Under direct vision, the tumor in the specimen bag was removed by clamping, pulling and reducing through the umbilical incision. All operations were successfully completed. The average number of leiomyomas removed was 1.94 (range, 1–11), and the mean tumor weight was 155.45 g (range, 40–665 g). The mean total tumor removal time, from endoscopic bag placement to umbilical incision repair, was 12.60 min (range, 6–28 min). The mean visual analog scale (VAS) scores evaluated on postoperatively day 1 was 2.59 (range, 1–4). Most of the removed lesions were diagnosed as benign leiomyoma on postoperative pathology, and no malignancy was observed in any resected samples. All cases were followed up through outpatient visits or telephone, and the average follow-up time was 7.55 months (range, 1–16 months). The umbilical incisions healed without complications, and there were no complaints of umbilical discomfort. TPRT was found to be safe, time-saving, cost-efficient, and easy to perform and learn. [ABSTRACT FROM AUTHOR]

Background: ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°‐unrestricted movement of the wrist joint, as in robotic surgery. Objective: The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. Methods: A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. Results: The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Conclusions: Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy. Synopsis: Myomectomy as performed with an ArtiSential instrument enabling free, 360°‐unrestricted movement of the wrist joint seems to be feasible and safe. [ABSTRACT FROM AUTHOR]

To study the specific mechanisms through which progesterone and selective progesterone receptor modulators impact the growth, synthesis, and accumulation of the extracellular matrix in uterine leiomyomas. Laboratory study. Academic Research Institutions. This study involved reproductive-age women diagnosed with infertility associated uterine leiomyomas who underwent myomectomy either after selective progesterone receptor modulator ulipristal acetate (UA) treatment or without any pharmacological pretreatment. Control samples included healthy myometrium tissue (n = 100). Specimens were obtained from the Department of Reproduction and Gynecological Endocrinology and Biobank, Medical University of Bialystok, Poland. Daily (5 mg/d) UA treated for 2 months (n = 100) and untreated (n = 150) patients with uterine leiomyomas or normal healthy myometrium (n = 100) tissue samples immediately after surgery were collected for transcriptional analysis and assessments. Progesterone-induced activation of the signaling pathways related to uterine leiomyomas extracellular matrix synthesis, deposition, and growth, as well as the expression profile of progesterone receptors in uterine leiomyomas, were assessed. The results indicated that progesterone activated the transforming growth factor-β and SMAD3 signaling pathways and promoted proliferation, growth, and extracellular matrix remodeling in uterine leiomyomas by up-regulating SMAD3, transforming growth factor-β (TGF-β) receptor type 1 and II, Ras homolog A, vascular endothelial growth factor, or increasing the fibrosis-related gene collagen, type I, ɑ-1, and procollagen, type I, ɑ-1 production. In contrast, UA had inhibitory effects on these processes. The study also showed that both nuclear and membrane progesterone receptors play distinct roles in uterine leiomyoma pathobiology. We showed that both nuclear and membrane progesterone receptors were relevant in the treatment of uterine leiomyomas, especially when combined with selective progesterone receptor modulators. Novel therapeutic approaches combining selective progesterone receptor modulators with or without direct and indirect extracellular matrix targeting through selected specifically TGF-β and SMAD3 (SMAD3, TGF-β receptor types 1 and II, Ras homolog A, vascular endothelial growth factor, collagen, type I, ɑ-1) signaling pathways could therefore be a treatment option for uterine leiomyomas. [ABSTRACT FROM AUTHOR]

• Use of artificial intelligence in fibroid management. In recent years, the integration of Artificial intelligence (AI) into various fields of medicine including Gynaecology, has shown promising potential. Surgical treatment of fibroid is myomectomy if uterine preservation and fertility are the primary aims. AI usage begins with the involvement of LLM (Large Language Model) from the point when a patient visits a gynecologist, from identifying signs and symptoms to reaching a diagnosis, providing treatment plans, and patient counseling. Use of AI (ChatGPT versus Google Bard) in the surgical management of fibroid. Identifying the patient's problems using LLMs like ChatGPT and Google Bard and giving a treatment option in 8 clinical scenarios of fibroid. Data entry was done using M.S. Excel and was statistically analyzed using Statistical Package for Social Sciences (SPSS Version 26) for M.S. Windows 2010. All results were presented in tabular form. Data were analyzed using nonparametric tests Chi-square tests or Fisher exact test. p values < 0.05 were considered statistically significant. The sensitivity of both techniques was calculated. We have used Cohen's Kappa to know the degree of agreement. We found that on the first attempt, ChatGPT gave general answers in 62.5 % of cases and specific answers in 37.5 % of cases. ChatGPT showed improved sensitivity on successive prompts 37.5 % to 62.5 % on the third prompt. Google Bard could not identify the clinical question in 50 % of cases and gave incorrect answers in 12.5 % of cases (p = 0.04). Google Bard showed the same sensitivity of 25 % on all prompts. AI helps to reduce the time to diagnose and plan a treatment strategy for fibroid and acts as a powerful tool in the hands of a gynecologist. However, the usage of AI by patients for self-treatment is to be avoided and should be used only for education and counseling about fibroids. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal. DATA SOURCES: Online searches: MEDLINE, Clinical-Trials.gov, PubMed, Cochrane Library, and PROSPERO Library from 1994 to 2023. METHODS OF STUDY SELECTION: A total of 5,143 studies were identified, with inclusion of 13 study groups. TABULATION, INTEGRATION AND RESULTS: Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates and ongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of less than 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinical pregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38-0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41-0.86). The ORs for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29-0.63) and, for ongoing pregnancy or livebirth rates, an OR at 0.38 (95% CI, 0.24-0.59). In data sets without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of 0.75 (95% CI, 0.58-0.96). Women with leiomyomas larger than 5 cm showed no differences in clinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI, 0.32-1.58). Although women with a single leiomyoma in any location had no differences in outcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing pregnancy or livebirth rates, with an OR of 0.62 (95% CI, 0.44-0.86) and 0.57 (95% CI, 0.36-0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramural leiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10 (95% CI, 0.77-1.59). CONCLUSION: Even small intramural leiomyomas are associated with lower fertility; removal does not confer benefit. Women with more than one leiomyoma in any location have reduced fertility. [ABSTRACT FROM AUTHOR]

Background. In recent years, due to the increase in medical malpractice complaints, the Sicilian Regional Health System has adopted procedures for the direct management of claims by each health facility with the aim of reducing the costs of insurance premiums and related taxes. Mandatory sentinel event monitoring is a crucial part of this strategy to improve patient safety and quality of care. The reported case relates to a laparoscopic myomectomy surgery performed by means of morcellation, a controversial technique. After the FDA's intervention in 2014, it is believed that morcellation may worsen the staging of the disease by spreading malignancies such as leiomyosarcoma into the abdomen. Case report. A 28-year-old woman, underwent laparoscopic surgery for uterine fibroids and an ovarian cyst removal in August 2018. Post-surgery, she was diagnosed with Leiomyoma. She returned to the hospital due to metrorrhagia and was discharged after a week. Persistent symptoms led to her readmission and subsequent exploratory laparoscopic surgery at another hospital. This resulted in a total hysterectomy and the discovery of uterine leiomyosarcoma, with FIGO STAGE IIIB staging. Despite chemotherapy, she passed away six months later. Discussion and Conclusions. This case highlights medical-legal issues. Informed consent for morcellation and its risks was not obtained. The morcellation technique was used, increasing cancer spread risk. The histopathological process was inadequate, with three biopsies leading to misdiagnosis. This could be medical malpractice, making providers legally responsible for the patient's deteriorating condition and the anticipation of possible death. [ABSTRACT FROM AUTHOR]

Disseminated peritoneal leiomyomatosis (DPL) is a rare condition marked by multiple leiomyomas in the peritoneal cavity, predominantly affecting women of reproductive age. Although typically benign, DPL can present significant diagnostic challenges and, in rare cases, may progress to malignancy. A primary contributing factor to DPL is iatrogenic, particularly due to surgical interventions such as morcellation during myomectomy. This scoping review explores the pathogenesis, epidemiology, diagnosis, and management of DPL, highlighting the crucial role of hormonal influences and iatrogenic factors. Diagnostic methods include computed tomography, ultrasound, magnetic resonance imaging, and histopathological evaluation, which are essential for assessing disease extent and guiding treatment. Management strategies encompass surgical intervention—with a focus on minimizing iatrogenic risks—conservative approaches for asymptomatic patients, and advancements in hormonal treatments. Emphasis is placed on preventing iatrogenic dissemination through refined surgical techniques and patient education. Despite its rarity, with fewer than 200 cases reported globally, understanding DPL's clinical presentation and iatrogenic origins is vital for optimal patient outcomes. This review underscores the importance of early diagnosis, personalized treatment plans, and ongoing research to address the challenges associated with DPL. [ABSTRACT FROM AUTHOR]

Abstract This study aims to objectively assess the effect of three surgical approaches for posterior uterine fibroid resection: transumbilical laparoendoscopic single-site surgery (LESS), vaginal natural orifice transluminal endoscopic surgery (vNOTES) in prone position (vNOTES-P), and vNOTES in the lithotomy position (vNOTES-L). A retrospective analysis was conducted on data pertaining to all patients who underwent vNOTES and LESS for single posterior fibroids at our institution from January 2023 to July 2023. Patients were categorized into three groups based on the surgical approach: vNOTES-P group (n = 30), vNOTES-L group (n = 17), and LESS group (n = 32). Comparative analysis was performed on the demographic characteristics and perioperative outcomes among the three groups of patients. All 79 patients underwent surgery without the need for conversion to laparotomy. There were no statistically significant differences among the LESS group, vNOTES-P group, and vNOTES-L group in terms of operative time, intraoperative blood loss, and perioperative complication rates. In the vNOTES-L group, two patients required conversion to LESS during surgery. Patients had faster return of bowel function (less time to flatus) in the vNOTES group compared to the LESS group (P

Abstract This review compares the efficacy of Uterine Artery Embolization (UAE) and Myomectomy (MYO) in managing symptomatic Uterine Fibroids (UFs) in women who do not want hysterectomy. A meta-analysis was performed on all available studies that evaluated the relative benefits and harms of MYO and UEA for the management of patients suffering from UFs. Outcomes evaluated reintervention, UFs scores for quality of life (QOL) and symptom severity, and other complications. To determine mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs), a random or fixed-effects model was utilized. A meta-analysis of 13 studies (9 observational and 4 randomized controlled trials) was conducted. The results indicated that UAE had a higher reintervention rate (OR 1.84; 95% CI 1.62–2.10; P

Uterocutaneous fistula is a rare pathology that commonly occurs following uterine surgeries, endometriosis, chronic infection, malignancy, and foreign bodies. Many diagnostic and management strategies have been practiced. In this case series, we describe three cases of uterocutaneous fistula following cesarean and myomectomy, which was diagnosed clinically, confirmed by magnetic resonance imaging, and managed successfully by surgery with fertility preservation.

Background: To determine the association of trainees involvement with surgical outcomes of abdominal and laparoscopic myomectomy including operative time, rate of transfusion, and complications. Methods: A retrospective cohort study of 1145 patients who underwent an abdominal or laparoscopic myomectomy from 2008-2012 using the American College of Surgeons National Surgical Quality Improvement Program database (Canadian Task Force Classification II-2). Results: Overall, 64% of myomectomies involved trainees. Trainees involvement was associated with a longer operative time for abdominal myomectomies (mean difference 20.17 minutes, 95% Confidence Interval (CI) [11.37,28.97], p< 0.01) overall and when stratified by fibroid burden. For laparoscopic myomectomy, there was no difference in operative time between trainees vs no trainees involvement (mean difference 4.64 minutes, 95% CI [-18.07,27.35], p = 0.67). There was a higher rate of transfusion with trainees involvement for abdominal myomectomies (10% vs 2%, p < 0.01; Odds Ratio (OR) 5.62, 95% CI [2.53,12.51], p < 0.01). Trainees involvement was not found to be associated with rate of transfusion for laparoscopic myomectomy (4% vs 5%, p = 0.86; OR 0.82, 95% CI [0.16,4.14], p = 0.81). For abdominal myomectomy, there was a higher rate of overall complications (15% vs 5%, p< 0.01; OR 2.96, 95% CI [1.77,4.93], p < 0.01) and minor complications (14% vs 4%, p < 0.01; OR 3.71, 95% CI [2.09,6.57], p < 0.01) with no difference in major complications (3% vs 2%, p = 0.23). For laparoscopic myomectomy, there was no difference in overall (6% vs 10% p = 0.41; OR 0.59, 95% CI [0.18,2.01], p = 0.40), major (2% vs 0%, p = 0.38), or minor (5% vs 10%, p = 0.32; OR 0.52, 95% CI [0.15,1.79], p = 0.30) complications. Conclusion: Trainees involvement was associated with increased operative time, rate of transfusion, and complications for abdominal myomectomy, however, did not impact surgical outcomes for laparoscopic myomectomy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth. Methods: A retrospective population‐based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6–11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18–34 vs ≥35 years old). Results: We observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22–3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49–14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6–11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14–2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16–9.24, P = 0.025) versus a TIMP of 6–11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17–4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17–3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06–15.53, P = 0.041); whereas women aged 18–34 years old did not. Conclusions: This study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old. Synopsis: A population‐based cohort study to investigate the association between myomectomy‐to‐pregnancy interval and obstetric outcomes. [ABSTRACT FROM AUTHOR]

Background Muscles affected by postparetic synkinesis have imbalanced tonicity that limit perioral mimetic movement and inhibit the ability to smile. The depressor anguli oris (DAO) muscle has been a common myectomy target for the treatment of perioral synkinesis. While addition of buccinator myectomies to DAO myectomies has risen, no studies have analyzed the effects of buccinator myectomies. The goal of this study was to evaluate and compare the effects of a DAO myectomy with and without concomitant buccinator myectomy through objective facial metrics and subjective patient-reported outcomes. Methods This study is a retrospective review of patients with postparetic synkinesis who underwent DAO myectomy (DAO myectomy group) or DAO myectomy with buccinator myectomy (DAO + Buccinator myectomies group). Outcomes included postoperative differences in objective smile measures (smile angle, excursion, and dental show) using validated software and patient-reported outcomes using the Facial Disability Index (FDI) questionnaire and a myectomy-specific questionnaire. Results After chart review, 18 patients were included in the DAO myectomy group and 19 in the DAO + Buccinator myectomies group. There were no significant postoperative differences between the groups in (1) smile excursion, angle, or dental show at resting, closed smile, or open smile (p > 0.05), (2) FDI physical and social scores, p = 0.198 and 0.932, respectively, or (3) myectomy-specific questionnaire responses (p > 0.05). Conclusion The addition of a buccinator myectomy to a DAO myectomy does not provide significant clinical benefit when compared with an isolated DAO myectomy, based on objective measures and subjective patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Objective: To share our case and offer guidance to practitioners on the management of incidental uterine surgery in early pregnancy. Although elective uterine surgery should be avoided during pregnancy, there is always a chance of undetected pregnancy at the time of surgery, even after all precautions have been taken. There is currently minimal literature on the management and outcomes of uterine surgery during pregnancy. Design: Case report. Setting: University Hospital. Patient: A 42-year-old G1P1 female with symptomatic fibroids desiring fertility-sparing surgery was retroactively found to be 4 weeks pregnant at the time of surgery, even after a negative pregnancy test and low suspicion for pregnancy under Centers for Disease Control and Prevention guidelines. Intervention: Robotic-assisted laparoscopic myomectomy performed with a false-negative urine pregnancy test at the time of surgery. Main Outcome Measures: Guidance for surveillance and management options during continued pregnancy after robotic uterine surgery and cavity disruption by a uterine manipulator performed at 4 weeks gestation that went undetected at the time of surgery. Results: The patient was able to undergo an uncomplicated delivery by cesarean section at 38 weeks and delivered a healthy infant. Conclusion: Using a multidisciplinary approach, we describe guidelines for antepartum surveillance uterine surgery during an undetected pregnancy, which resulted in the delivery of a term healthy infant.

Objective To evaluate the efficacy of simultaneous or staged management of uterine fibroids by transcervical resection of septum （TCRS）， reproductive endocrinology and clinical prognosis. Methods Clinical data of 87 patients with uterine septum complicated with uterine fibroids were collected. All patients were divided into the simultaneous （n = 43） and staged groups （n = 44） according to different surgical methods. In the simultaneous group， hysteroscopic TCRS and transcervical resection of myoma （TCRM） were performed simultaneously， whereas staged hysteroscopic TCRS and TCRM were conducted in the staged group. Surgical conditions， postoperative myometrial healing， endometrial and subendometrial blood flow parameters （flow index （FI）， vascularization flow index （VFI） and vascularization index （VI））， endometrial thickness， reproductive endocrine indexes （luteinizing hormone （LH）， follicle stimulating hormone （FSH）， estradiol （E2））， reproductive outcomes and complications were compared between two groups. Results All patients in both groups completed the surgery successfully. The operation time， time to the first off-bed activity and the length of hospital stay in the simultaneous group were shorter than those in the staged group （all P < 0.05）. In the simultaneous group， the proportion of patients with myometrial healing at 1 month after surgery was higher than that in the staged group （P < 0.05）. The differences in subendometrial VFI， FI， VI， endometrial thickness and E2， LH and FSH levels before surgery， 1 month and 3 months after surgery were not statistically significant between two groups （all P > 0.05）. The percentage of patients who were pregnant at postoperative 6 months in the simultaneous group was higher than that in the staged group （P < 0.05）. The difference in the incidence of complication was not statistically significant between two groups （P > 0.05）. Conclusions Simultaneous management of uterine fibroids by TCRS does not affect endometrial hemodynamics， endometrial tolerance， ovarian reserve function and reproductive endocrine function. In addition， it can shorten the operation time， time to the first off-bed activity and length of hospital stay， which is conducive to postoperative pregnancy and has a certain degree of safety.

Diffuse uterine leiomyomatosis (DUL) is a prevalent leiomyoma variant in women of childbearing age, characterized by a uniformly enlarged uterus with numerous interconnected small myomas. Given that most DUL patients are in their reproductive years, treatments that preserve fertility are increasingly vital. This case report introduces an innovative hysteroscopic technique that forgoes uterine distension to remove multiple submucosal fibroids in a single procedure, maintaining endometrial integrity and fertility. A 27‐year‐old single woman experienced prolonged and heavier menstruation. Magnetic resonance imaging (MRI) scans showed an enlarged uterus with several round‐like masses in the uterine wall/submucosa. Addressing the patient's financial limitations and treatment preferences, a groundbreaking hysteroscopic surgery was performed using thoracic tissue forceps, alongside bedside ultrasonography, enabling fibroid excision without uterine distension. In total, 38 uterine fibroids were successfully excised without complications such as uterine perforation or hyponatremia. According to the FIGO classification system: three were type III, nine were type II, 15 were type I, and 11 were type 0. Postoperative follow‐up indicated normalized menstrual cycles, improved hemoglobin levels, and no recurrence of fibroids. A hysteroscopic examination 1 month after surgery revealed no significant fibroids or endometrial thickening. This case report underscores the effectiveness of a novel hysteroscopic surgical approach in treating DUL. This method eliminates the need for multiple staged surgeries and the risks of endometrial damage inherent in traditional techniques. It offers a minimally invasive, fertility‐preserving alternative for young DUL patients, marking a significant advancement in gynecologic surgery. [ABSTRACT FROM AUTHOR]

\nSYNOPSISBackground: Inferior oblique muscle overaction (IOOA) is a prevalent ocular muscle motility disorder. This study aimed to investigate the outcomes and impact of IO muscle myectomy with and without tucking the proximal end of the muscle into Tenon’s capsule in two surgical groups as a treatment for IOOA. Methods: Randomized cohort study that involves two surgical groups. A total of 33 patients (55 eyes). Patients were randomly divided into two groups: first group underwent myectomy without tucking the proximal end of the muscle, whereas the second group underwent myectomy with tucking of the proximal end of the muscle. Each patient had four visits. During each visit, each patient had a comprehensive ophthalmic examination. Surgical success was defined as IOOA grade range of 0 to + 1 and correction of hypertropia in primary gaze. Results: The median age was 6 years. Sixteen (48.5%) patients underwent IO muscle myectomy with tucking, while 17 (51.5%) had an IO myectomy without tucking. Both the tucking and without tucking groups showed reductions in the angles of deviations, but there was no significant difference between the groups at baseline or postoperatively at 6 months. The success rate was 92.85% for the tucking group and 92.59% for the without tucking group. Conclusion: The study suggests that both surgical techniques are effective in correcting IOOA and associated HT, without any clear benefits of the addition of tucking. Ultimately, the two surgical techniques are equally effective, and the choice of surgical technique remains a personal preference of the surgeon.The study found that incorporating myectomy with tucking the proximal end of the muscle into Tenon’s capsule does not improve the overall effectiveness of surgery. Yet, the decision to include tucking remains a personal choice for the surgeon. [ABSTRACT FROM AUTHOR]

This article examines the costs and carbon emissions associated with virtual preoperative visits in a gynecologic surgery practice. The study found that virtual visits significantly reduced driving costs, CO2 emissions, and driving time compared to in-person visits, with no negative impact on surgical outcomes. The authors emphasize the potential environmental benefits of telemedicine in reducing carbon footprints in healthcare. However, the study has limitations, including its retrospective design and single-center setting. [Extracted from the article]

Background: Uterine leiomyomas (often referred to as fibroids or myomas) are common benign, hormone-dependent tumors that grow in the uterus and occur in approximately 25% of reproductive age women, depending on selected population. Treatment recommendation is typically based on fibroid size, location, the patient's age, reproductive plans, and obstetrical history. Despite the range of treatment options available for uterine fibroids and their symptoms, including hysterectomy, myomectomy, endometrial ablation, endometrial uterine artery embolization, and magnetic resonance-guided focused-ultrasound surgery, myomectomy remains the gold standard treatment for patients who desire fertility-preserving surgery for their uterine fibroids. Myomectomy, while a prevalent surgical option for the removal of fibroids, carries known risks such as fibroid recurrence, symptom recurrence, and the subsequent need for reintervention. Despite ongoing research and advances in medical treatments for fibroids, there currently are no universally recommended therapeutic interventions proven to effectively delay the recurrence of fibroids or the return of symptoms following this procedure. This situation underscores a significant area of unmet medical need and highlights the importance of continued investigation into preventive strategies and long-term management options for patients undergoing fibroid removal with uterine preservation. We designed a study to assess the efficacy of the new FDA-approved GnRH antagonist, Myfembree in delaying the return of fibroids and their associated symptoms. Methods: A randomized, prospective, open-label clinical trial. The participants (n = 136) will be randomly distributed into two groups. The Control Group (Standard of care) will receive treatment with standard of care (SoC) after surgical myomectomy and the treatment group will receive Relugolix combination therapy (Myfembree®) after surgical myomectomy. The study protocol was approved by the University of Chicago's Institutional Review Board (IRB#22–0282), ensuring that all participants would provide written informed consent before their inclusion. Discussion: In this project, we propose the use of daily dosed Relugolix combination therapy (Relugolix with estradiol and norethindrone acetate), which is approved for uterine fibroids treatment, has the potential to delay the recurrence of fibroid symptoms, prolong the improved quality of life and delay need for re-intervention after uterine sparing surgery. Trial registration: The study protocol was approved by the Institutional Review Board of the University of Chicago on 9/16/2022 and was registered at ClinicalTrials.gov with number NCT05538689 on Sep 7, 2022. All subjects will provide informed consent to participate. [ABSTRACT FROM AUTHOR]

Uterine fibroids (UFs) are the most common female benign pelvic tumors, affecting >60% of patients aged 30–44 years. Uterine fibroids are asymptomatic in a large percentage of cases and may be identified incidentally using a transvaginal ultrasound or a magnetic resonance imaging scan. However, in approximately 30% of cases, UFs affect the quality of life and women's health, with abnormal uterine bleeding and heavy menstrual bleeding being the most common complaints, along with iron deficiency (ID) and ID anemia. Medical treatments used for UFs-related abnormal uterine bleeding include symptomatic agents, such as nonsteroidal antiinflammatory drugs and tranexamic acid, and hormonal therapies, including combined oral contraceptives, gonadotropin-releasing hormone agonists or antagonists, levonorgestrel intrauterine systems, selective progesterone receptor modulators, and aromatase inhibitors. Nevertheless, few drugs are approved specifically for UF treatment, and most of them manage the symptoms. Surgical options include fertility-sparing treatments, such as myomectomy, or nonconservative options, such as hysterectomy, especially in perimenopausal women who are not responding to any treatment. Radiologic interventions are also available: uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound, and radiofrequency ablation. Furthermore, the management of ID and ID anemia, as a consequence of acute and chronic bleeding, should be taken into account with the use of iron replacement therapy both during medical treatment and before and after a surgical procedure. In the case of symptomatic UFs, the location, size, multiple UFs, or coexistent adenomyosis should guide the choice with a shared decision-making process, considering long- and short-term treatment goals expected by the patient, including pregnancy desire or wish to preserve the uterus independently of reproductive goals. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the short-term effects of inferior oblique myectomy on the retinal neurovasculature, choroidal thickness, and choroidal vascularity index at the macula. Methods: Patients older than 5 years who were candidates for inferior oblique muscle myectomy surgery participated in the study. Patients with any systemic or ocular disease that could affect the macular neurovasculature were not included in the study. After recording demographic data, including age and gender, and conducting a complete ophthalmic examination, macular optical coherence tomography (OCT), enhanced depth imaging OCT, and OCT angiography imaging (AngioVue software (V.2017.1.0.151; Optovue, Inc) were performed before (1 day to 1 week) and in the specific time intervals (1 week, 1 month, and 3 months) after the surgery for all participants. Results: Eighteen patients (13 male and 5 female) who underwent inferior oblique muscle myectomy, with a mean ± standard deviation age of 24.22 ± 18.14 years, were included in this study. The baseline mean ± standard deviation of subfoveal choroidal luminal area and subfoveal total choroidal area were 0.390 ± 0.03 and 0.539 ± 0.04 mm2, respectively. The changing pattern of the subfoveal choroidal vascularity index and subfoveal choroidal luminal area was statistically significant (P =.013 and.035, respectively). Conclusions: Inferior oblique myectomy can lead to changes in choroid hemodynamics in the short term. However, these changes seem to be temporary. [J Pediatr Ophthalmol Strabismus. 2024;61(4):235–244.] [ABSTRACT FROM AUTHOR]

Distinguishing between leiomyosarcoma and benign uterine leiomyoma, as one of the common problems in reproductive age, brings a great challenge in dealing with patients. Clinical findings, imaging report, tumor markers, endometrial biopsy, and even age of the patients will not be helpful to make this distinction. So, the important question is when we should consider leiomyosarcoma probability? In this report, an unexpected case of leiomyosarcoma with a poor prognosis is presented. A 45-year-old female patient gravida 3 with complaint of hypermenorrhea from one year ago was presented to the gynecologic department. The patient did not mention anything special in her medical history. At last, a hysterectomy was planned due to her irreversible bothering symptom. The final histologic report was leiomyosarcoma in the smallest myomatous mass of the uterus, and her post-operation CT scan with contrast of abdomen-pelvic revealed several metastatic focuses. Uterine sarcomas as one of the most important causes of mortality worldwide have a low incidence and defining the standard treatment and the exact prognosis require further study. More definitive ways to differentiate benign uterine leiomyoma from leiomyosarcoma including genetic studies, specific imaging techniques, specific tumor markers, and investigating the method of intrauterine biopsy by flexible or robotic hysteroscopy are needed. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the safety and efficacy of myomectomy for recurrent uterine fibroids (UFs) after high‐intensity focused ultrasound (HIFU) ablation.This was a retrospective study. Patients who underwent abdominal myomectomy (AM) and laparoscopic myomectomy (LM) from January 2018 to December 2021 at the Three Gorges Hospital of Chongqing University were included. Among them, 73 had undergone prior HIFU ablation (Group 1), while 120 had not undergone HIFU (Group 2). Outcome measures included operating time, estimated blood loss (EBL), blood transfusion, postoperative activity times (PAT), duration of hospital stay (DOHS), and complications.The operating time was 90.0 min (70.5, 115.0) for Group 1 and 110.0 min (81.5, 130.0) for Group 2 (P < 0.05). During all AM pathways, there were no significant differences observed between the two groups in EBL, blood transfusion, PAT, DOHS, and complications; however, operating time was shorter in Group 1. The operating time, EBL, blood transfusion, PAT, DOHS, and complications were similar in both groups during LM pathway. During the follow‐up 40 (range: 24–53) months, the rate of relief, recurrence, and reintervention in Groups 1 and 2 was 78.1% versus 74.1%, 14.6% versus 16.4%, and 3.7% versus 2.6%, respectively (P > 0.05).Myomectomy is a safe and effective surgical method for treating recurrent UFs after HIFU. Myomectomy for treating recurrent UFs resulted in a shorter operative and hospital stay, reduced blood loss, faster postoperative recovery, and fewer complications, better symptom relief rates, and lower risk of recurrence or reintervention. These findings indicate that previous HIFU ablation does not worsen the outcomes of the subsequent myomectomy. [ABSTRACT FROM AUTHOR]

Objective: To estimate the incidence and report the details of hystological, clinical, surgical, and demographic features of incidental uterine sarcomas in patients operated with symptomatic myoma uteri. Material and Methods: We designed a retrospective cohort study at Adnan Menderes University Gynecologic Oncology Department that includes totally 896 patients with symptomatic myoma uteri who were operated as a hysterectomy or myomectomy. Following the definition of inclusion and exlusion criterias, incidental uterine sarcoma cases were detailed as histological subtype, tumor diameter, morcellation or fragmentation status in surgery, adjuvant treatment, recurrences, and survival. All cases were reported as a table without specific statistical analyzes. Results: A total of 775 hysterectomy and 121 myomectomy cases were analyzed. Fourteen sarcoma cases were reported. Two sarcoma cases were excluded due to adnexal sarcoma in final pathology. Ten cases were reported in final pathology incidentally. 7/10 cases were reported as leiomyosarcoma while low grade endometrial stromal sarcoma were reported in 2 cases. While all recurrences were seen in leiomyosarcoma group (5 cases), two of them died with disease-related complications. Conclusion: Studies have shown that uterine sarcomas are malignancies that are extremely rare and cannot be predicted preoperatively. Due to its low incidence and uncertain tumor behavior, in low-risk patients, myomectomy with mechanical or power morcellation is a safe surgical option when it is perfomed without abdominal spillage which can be common in laparoscopic surgery. [ABSTRACT FROM AUTHOR]

The uterine tourniquet is often not used to reduce intraoperative blood loss due to controversial opinions in the literature. The objective was to evaluate the effectiveness of this procedure in laparotomic myomectomy. This is a retrospective, monocentric case-control study, including patients who underwent laparotomic myomectomy and were categorized into the Tourniquet Group (A) and No Tourniquet Group (B). The blood loss outcomes were compared. Intra-operative blood loss in Group A was 275 ± 200 mL, while in Group B was 410 ± 390 mL (p = 0.11). Notably, five patients in the No Tourniquet Group lost more than 1000 mL of blood and required blood transfusion, while no such cases were reported in the Tourniquet Group. Furthermore, the decrease in hemoglobin post-procedure was statistically significant, favoring Group A with a decrease of 1.9 ± 0.7 g/dL compared to Group B's 2.8 ± 2.2 g/dL (p = 0.04). The use of the Foley catheter as a tourniquet during laparotomic myomectomy may represent a remarkable tool that profoundly impacts the surgical process by substantially reducing blood loss. Its use may play a role in significantly diminishing the likelihood of requiring blood transfusions, enhancing patient safety and outcomes, and should be systematically adopted. [ABSTRACT FROM AUTHOR]

Background and Aim: Uterine fibroids are common benign female neoplasms which are frequently managed by myomectomy to preserve fertility. It is a bloody procedure due its rich blood supply. The application of uterotonics, like oxytocin, has been recommended to decrease blood loss. Carbetocin is a synthetic analogue of oxytocin, that has a more rapid onset and prolonged action. This study was conducted to evaluate the effect of carbetocin as an utero-tonic agent on reducing blood loss during hysteroscopic myomectomy. Patients and Methods: We included 40 women with submucous myomas and scheduled for hysteroscopic myomectomy in this prospective randomized trial. They were randomly assigned into two groups; Group A received IV carbetocin (1 ml), and Group B (placebo). Intraoperative bleeding was classified as mild, moderate, and severe, whereas the quality of operative field was classified as good, fair, or poor. Results: Both patient and disease criteria were statistically comparable between the two study groups. However, operative time was significantly prolonged in Group B (33.2 vs. 30.35 minutes in the other group - p = 0.044). The amount of intraoperative bleeding was significantly increased in the same group (p = 0.038). Although preoperative hemoglobin and hematocrit values were comparable between the two groups, both parameters showed a significant decline in the placebo group. Both the quality of operative field and surgeon satisfaction were significantly improved with carbetocin administration. Conclusion: Carbetocin administration is recommended during hysteroscopic myomectomy to decrease blood loss and improve surgeon satisfaction. [ABSTRACT FROM AUTHOR]

• Laparoscopic myomectomy offers multiple benefits, including reduced blood loss, shorter hospital stays, and less postoperative analgesic need. • The intra-operative or post-operative complications rate are similar between laparoscopic and laparotomic myomectomy. • Laparoscopic approach could be a valid alternative to laparotomic one, in selected patients. Surgeon's experience, the suitability of the patient, and the size, location, and number of uterine fibroids are the several critical factors that influencing the choice of surgical approach in uterine leiomyoma management. Myomectomy is one of the most common surgical procedure in the field of gynecology. However, the role of laparoscopic myomectomy is still debated for many factors, including surgical considerations, safety and fertility concerns, long-term outcomes, and cost-related issues. The aim of this study is to evaluate the surgical peri- and post-operative outcomes of laparoscopic and abdominal myomectomy. A systematic search for studies was performed up to June 2023 through MEDLINE, Pubmed, Embase. Studies reporting the comparison of surgical and obstetrical outcomes in laparoscopic versus laparotomic myomectomy were included for the following outcomes: time of surgery, estimated blood loss, decrease of postoperative hemoglobin, hospital stay, intra-operative complication rates, postoperative complications rates, postoperative analgesic use, postoperative pain at 24 h and pregnancy rate. The meta -analysis was performed using the Cochrane Review software. Fifty-six relevant articles were retrieved through the process of evidence acquisition. Eleven articles met inclusion criteria, for a total of 2,133 patients undergoing laparoscopic or laparotomic myomectomy. The estimated blood loss [standard mean differences (SMD) 0.72, IC 95 % 0.22 to 1.22], the hospital stays [SMD 3.12, IC 95 % 0.57 to 4.28], were significantly lower in laparoscopic than in open group. No statistically significant difference in intra-operative and post-operative complication rates, in pregnancy rate and others obstetrical outcomes between two surgical approaches were found. The findings of present metanalysis suggest that laparoscopic myomectomy offers multiple benefits, including reduced blood loss, shorter hospital stays, and less postoperative analgesic need, without a significant increase in complication rates and similar results in obstetrical outcomes when compared to abdominal myomectomy. However, the presence of few randomized studies on selected population may limit the generalizability of the findings to the entire population. Therefore, more well-designed studies or large population program data to draw definitive conclusions are therefore warranted. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20–30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively. The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI). Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent. [ABSTRACT FROM AUTHOR]

Introduction: Uterine artery embolization (UAE) and hysterectomy are often used to treat uterine myoma. Nevertheless, the impact of these two treatments on postoperative ovarian function remains uncertain. Aim: To compare the postoperative ovarian function in individuals with uterine myoma who had UAE against hysterectomy. Material and methods: Searches were conducted in the Wanfang, Web of Science, and PubMed databases to find qualifying studies. The data were combined and analyzed. Results: Seven publications were included in this meta-analysis. Uterus and uterine myoma volume were dramatically decreased by UAE (p < 0.00001 for both). The combined preoperative levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) were similar in both groups. Three months postoperatively, the combined FSH (p = 0.28) and LH (p = 0.64) levels were similar in both groups, while the combined E2 level was notably higher in the UAE group compared to the hysterectomy group (p < 0.00001). Six months postoperatively, the combined postoperative FSH and LH levels were considerably lower in the UAE group compared to the hysterectomy group (p = 0.002 for both). However, the combined E2 levels were similar between the two groups (p = 0.07). Also, 12 months after surgery, the combined postoperative FSH and LH levels were remarkably lower in the UAE group compared to the hysterectomy group (p = 0.02 and p < 0.00001, respectively). However, the combined E2 levels were similar in both groups (p = 0.15). Conclusions: UAE may provide superior preservation of postoperative ovarian function compared to hysterectomy in individuals with uterine myoma. [ABSTRACT FROM AUTHOR]

In this study, unipolar myomectomy was used to address limited neck movement and tight muscles in pediatric, adolescent, and adult patients. A retrospective chart review was performed for patients from January 2006 to February 2023, who were diagnosed with congenital muscular torticollis and underwent a unipolar myomectomy. Outcome evaluation, adapted from the Cheng and Tang system — cervicomandibular angle (CMA), facial asymmetry, cranial asymmetry, tilting limitation (TL), rotation limitation (RL), subjective assessment, and residual contracture — included various parameters scored from 0 to 3 points and categorized as poor, fair, good, or excellent. In total, the data for 36 patients (21 males and 15 females) were analyzed. Participants were aged 0.8–38 years. Surgery improved CMA, RL, and TL, with no complications (12.2°–1.2°, 18.6°–5.2°, and 17.6°–6.5° for CMA, RL, and TL, respectively; p < 0.001). The mean overall score was comparable among different age groups (2.8 ± 0.5, 2.2 ± 0.62, and 2.1 ± 0.37 for the pediatric, adolescent, and adult groups, respectively). Within the limitations of the study it seems that unipolar myomectomy is a promising, effective surgical option for individuals of multiple age groups. [ABSTRACT FROM AUTHOR]

To investigate postoperative surgical and non-surgical complications that occur within 30 days following myomectomy procedures, whether laparoscopic or via open surgery. Prospective cohort study Del Ponte Women's and Children's Hospital, Varese, Italy. Women undergoing myomectomy either with laparoscopic or open surgery from July 2020 to June 2023 Data of consecutive patients who underwent abdominal myomectomy procedures, either via laparoscopy or open abdominal surgery were collected. The study examined patient characteristics, size and location of fibroids, surgical data, and complications. Univariate and multivariable analyses were employed to identify factors contributing to postoperative Clavien-Dindo grade ≥ II complications. Overall 383 patients were included in the study. The univariate analysis showed intramural fibroid type (p =.0009), large fibroid size (p =.03), and extended operative times (p =.05) were associated with postoperative complications. Open surgical approach (p <.001) and uterine cavity opening (p =.02) also contributed to complications. Postoperative anemia emerged as the most prevalent complication. In the multivariable analysis, the open surgical approach emerged as the only independent factor associated with an increased risk of grade ≥ II complications (odds ratio 7.37; p <.0001). In this study we found an increased likelihood of complications in case of open myomectomy. While the presence of potential selection bias may have impacted this finding, it could provide valuable insights for clinicians and surgical teams in the strategic planning of myomectomy procedures. [ABSTRACT FROM AUTHOR]