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Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports.
Hum Reprod. 2012 Feb; 27(2):427-35.HR

Abstract

BACKGROUND

Our aim was to assess surgical complaints and reproductive outcomes of laparoscopic intracapsular myomectomies by a prospective observational study run in University affiliated hospitals.

METHODS

Between 2005 and 2010, 235 women underwent subserous and intramural laparoscopic myomectomy of fibroids (4-10 cm in diameter) for indications of pelvic pain, menstrual disorders, a large growing myoma or infertility. The main outcome measures were post-surgical parameters, including complications, the need for subsequent surgery or symptomatic relief, resumption of normal life and reproductive outcome.

RESULTS

Pelvic pain occurred in 27%, menorrhagia or metorrhagia in 21%, a large growing myoma in 10% and infertility in 42% of women. Single fibroids occurred in 51.9% of patients while 48.1% had multiple myomas. Of all patients, 58.2% had subserosal and 41.8% had intramural myomas. No laparoscopies were converted to laparotomy. In 3 years, 1.2% of patients had a second laparoscopic myomectomy for recurrent fibroids. The mean total operative laparoscopic time was 84 min (range 25-126 min), with mean blood loss of 118 ± 27.9 ml. By 48 h after surgery, 86.3% were discharged with no major post-operative complications. No late complications, such as bleeding, urinary tract infections or bowel lesions, occurred. Of the women who underwent myomectomy for infertility, 74% finally conceived. At term, 32.9% of patients underwent Caesarean section, 24.8% delivered by vacuum extractor and 42.2% had spontaneous deliveries. No case of uterine rupture occurred.

CONCLUSIONS

Intracapsular subserous and intramural myomectomy saving the fibroid pseudocapsule showed few early and no late surgical complications, enhanced healing by preserving myometrial integrity and allowed a good fertility rate and delivery outcome. In young patients suffering fibroids, laparoscopic intracapsular myomectomy is a potential recommended surgical treatment.

Authors+Show Affiliations

Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, P.zza Muratore, 73100 Lecce, Italy. andreatinelli@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

22095838

Citation

Tinelli, Andrea, et al. "Laparoscopic Myomectomy Focusing On the Myoma Pseudocapsule: Technical and Outcome Reports." Human Reproduction (Oxford, England), vol. 27, no. 2, 2012, pp. 427-35.
Tinelli A, Hurst BS, Hudelist G, et al. Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports. Hum Reprod. 2012;27(2):427-35.
Tinelli, A., Hurst, B. S., Hudelist, G., Tsin, D. A., Stark, M., Mettler, L., Guido, M., & Malvasi, A. (2012). Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports. Human Reproduction (Oxford, England), 27(2), 427-35. https://doi.org/10.1093/humrep/der369
Tinelli A, et al. Laparoscopic Myomectomy Focusing On the Myoma Pseudocapsule: Technical and Outcome Reports. Hum Reprod. 2012;27(2):427-35. PubMed PMID: 22095838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports. AU - Tinelli,Andrea, AU - Hurst,Brad S, AU - Hudelist,Gernot, AU - Tsin,Daniel Alberto, AU - Stark,Michael, AU - Mettler,Liselotte, AU - Guido,Marcello, AU - Malvasi,Antonio, Y1 - 2011/11/16/ PY - 2011/11/19/entrez PY - 2011/11/19/pubmed PY - 2012/5/19/medline SP - 427 EP - 35 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 27 IS - 2 N2 - BACKGROUND: Our aim was to assess surgical complaints and reproductive outcomes of laparoscopic intracapsular myomectomies by a prospective observational study run in University affiliated hospitals. METHODS: Between 2005 and 2010, 235 women underwent subserous and intramural laparoscopic myomectomy of fibroids (4-10 cm in diameter) for indications of pelvic pain, menstrual disorders, a large growing myoma or infertility. The main outcome measures were post-surgical parameters, including complications, the need for subsequent surgery or symptomatic relief, resumption of normal life and reproductive outcome. RESULTS: Pelvic pain occurred in 27%, menorrhagia or metorrhagia in 21%, a large growing myoma in 10% and infertility in 42% of women. Single fibroids occurred in 51.9% of patients while 48.1% had multiple myomas. Of all patients, 58.2% had subserosal and 41.8% had intramural myomas. No laparoscopies were converted to laparotomy. In 3 years, 1.2% of patients had a second laparoscopic myomectomy for recurrent fibroids. The mean total operative laparoscopic time was 84 min (range 25-126 min), with mean blood loss of 118 ± 27.9 ml. By 48 h after surgery, 86.3% were discharged with no major post-operative complications. No late complications, such as bleeding, urinary tract infections or bowel lesions, occurred. Of the women who underwent myomectomy for infertility, 74% finally conceived. At term, 32.9% of patients underwent Caesarean section, 24.8% delivered by vacuum extractor and 42.2% had spontaneous deliveries. No case of uterine rupture occurred. CONCLUSIONS: Intracapsular subserous and intramural myomectomy saving the fibroid pseudocapsule showed few early and no late surgical complications, enhanced healing by preserving myometrial integrity and allowed a good fertility rate and delivery outcome. In young patients suffering fibroids, laparoscopic intracapsular myomectomy is a potential recommended surgical treatment. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/22095838/Laparoscopic_myomectomy_focusing_on_the_myoma_pseudocapsule:_technical_and_outcome_reports_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/der369 DB - PRIME DP - Unbound Medicine ER -