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Laparoscopic Management of Huge Myoma Nascendi.
J Minim Invasive Gynecol. 2017 Mar - Apr; 24(3):347-348.JM

Abstract

STUDY OBJECTIVE

To demonstrate the feasibility of laparoscopic management of a huge myoma nascendi.

DESIGN

Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C).

SETTING

Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2].

INTERVENTIONS

A 35-year-old woman was admitted to our clinic with complaints of chronic pelvic pain and heavy menstrual bleeding. Her medical history included multiple hospitalizations for blood transfusions, along with a recently measured hemoglobin level of 9.5 g/dL and a hematocrit value of 29%. She had never been married and had no children. Pelvic ultrasonography revealed a 12 × 10-cm uterine myoma located on the posterior side of the corpus uteri and protruding through to the cervical channel. This was a huge intramural submucous myoma in close proximity to the endometrial cavity and spreading through the myometrium. On vaginal examination, the myoma was found to extend into the vagina through the cervical channel. Laparoscopic myomectomy was planned because of the patient's desire for fertility preservation. Abdominopelvic exploration revealed a huge myoma filling the posterior side of the corpus uteri and extending to the isthmus uteri and cervical channel. A myomectomy was performed using standard technique as described elsewhere. A vertical incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. During the procedure, the endometrial cavity was torn and was closed with 2-0 Vicryl separately. Total intraoperative blood loss was 250 mL, the total weight of the myoma was 245 g, and the operation lasted about 120 minutes. The patient experienced no intraoperative complications. She was discharged on postoperative day 1 and did not exhibit any problems at follow-up. The final histopathological examination confirmed the diagnosis of uterine leiomyoma.

CONCLUSION

Laparoscopic management of huge myomas in difficult locations appears to be a feasible and safe surgical option, especially in experienced hands.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey. Electronic address: dr.ata1980@hotmail.com.Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey.Department of Obstetrics and Gynecology, Acibadem University Atakent Hospital, İstanbul, Turkey.

Pub Type(s)

Case Reports
Journal Article
Video-Audio Media

Language

eng

PubMed ID

27632930

Citation

Peker, Nuri, et al. "Laparoscopic Management of Huge Myoma Nascendi." Journal of Minimally Invasive Gynecology, vol. 24, no. 3, 2017, pp. 347-348.
Peker N, Gündoğan S, Şendağ F. Laparoscopic Management of Huge Myoma Nascendi. J Minim Invasive Gynecol. 2017;24(3):347-348.
Peker, N., Gündoğan, S., & Şendağ, F. (2017). Laparoscopic Management of Huge Myoma Nascendi. Journal of Minimally Invasive Gynecology, 24(3), 347-348. https://doi.org/10.1016/j.jmig.2016.09.003
Peker N, Gündoğan S, Şendağ F. Laparoscopic Management of Huge Myoma Nascendi. J Minim Invasive Gynecol. 2017 Mar - Apr;24(3):347-348. PubMed PMID: 27632930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic Management of Huge Myoma Nascendi. AU - Peker,Nuri, AU - Gündoğan,Savas, AU - Şendağ,Fatih, Y1 - 2016/09/12/ PY - 2016/08/14/received PY - 2016/09/03/accepted PY - 2016/9/17/pubmed PY - 2017/7/15/medline PY - 2016/9/17/entrez KW - Cervical myoma KW - Laparoscopy KW - Myoma nascendi KW - Myomectomy SP - 347 EP - 348 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 24 IS - 3 N2 - STUDY OBJECTIVE: To demonstrate the feasibility of laparoscopic management of a huge myoma nascendi. DESIGN: Step-by-step video demonstration of the surgical procedure (Canadian Task Force classification III-C). SETTING: Uterine myoma is the most common benign neoplasm of the female reproductive tract, with an estimated incidence of 25% to 30% at reproductive age [1,2]. Patients generally have no symptoms; however, those with such symptoms as severe pelvic pain, heavy uterine bleeding, or infertility may be candidates for surgery. The traditional management is surgery; however, uterine artery embolization or hormonal therapy using a gonadotropin-releasing hormone agonist or a selective estrogen receptor modulator should be preferred as the medical approach. Surgical management should be performed via laparoscopy or laparotomy; however, the use of laparoscopic myomectomy is being debated for patients with huge myomas. Difficulties in the excision, removal, and repair of myometrial defects, increased operative time, and blood loss are factors keeping physicians away from laparoscopic myomectomy [1,2]. INTERVENTIONS: A 35-year-old woman was admitted to our clinic with complaints of chronic pelvic pain and heavy menstrual bleeding. Her medical history included multiple hospitalizations for blood transfusions, along with a recently measured hemoglobin level of 9.5 g/dL and a hematocrit value of 29%. She had never been married and had no children. Pelvic ultrasonography revealed a 12 × 10-cm uterine myoma located on the posterior side of the corpus uteri and protruding through to the cervical channel. This was a huge intramural submucous myoma in close proximity to the endometrial cavity and spreading through the myometrium. On vaginal examination, the myoma was found to extend into the vagina through the cervical channel. Laparoscopic myomectomy was planned because of the patient's desire for fertility preservation. Abdominopelvic exploration revealed a huge myoma filling the posterior side of the corpus uteri and extending to the isthmus uteri and cervical channel. A myomectomy was performed using standard technique as described elsewhere. A vertical incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. During the procedure, the endometrial cavity was torn and was closed with 2-0 Vicryl separately. Total intraoperative blood loss was 250 mL, the total weight of the myoma was 245 g, and the operation lasted about 120 minutes. The patient experienced no intraoperative complications. She was discharged on postoperative day 1 and did not exhibit any problems at follow-up. The final histopathological examination confirmed the diagnosis of uterine leiomyoma. CONCLUSION: Laparoscopic management of huge myomas in difficult locations appears to be a feasible and safe surgical option, especially in experienced hands. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/27632930/Laparoscopic_Management_of_Huge_Myoma_Nascendi_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(16)31043-3 DB - PRIME DP - Unbound Medicine ER -