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Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series.
Gynecol Surg. 2020; 17(1):7.GS

Abstract

Background

Non-hysteroscopic myomectomy is infrequently performed in a freestanding ambulatory setting, in part due to risks of intraoperative hemorrhage. There are also concerns about increased surgical risks for morbidly obese patients in this setting. The purpose of this study is to report the surgical outcomes of a series of laparoscopic-assisted myomectomy (LAM) cases at a freestanding ambulatory surgery center (ASC), including a comparative analysis of outcomes in morbidly obese patients (BMI > 40 kg/m2).

Methods

A retrospective comparative analysis was performed of 969 women, age 18 years or older, non-pregnant, who underwent LAM by one of two high volume, laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and February 2019. Reversible occlusion was performed laparoscopically by placing a latex-based rubber catheter as a tourniquet around the isthmus of the uterus, causing a temporary occlusion of the bilateral uterine arteries. Permanent occlusion was performed laparoscopically via retroperitoneal dissection and uterine artery ligation at the origin of the anterior branch of the internal iliac artery. Minilaparotomy was performed for specimen removal in all cases. No power morcellation was used. Postoperative complications were graded using the Clavien-Dindo Classification system. Outcomes were compared across BMI categories using Pearson Chi-Square.

Results

Average myoma weight and size were 422.7 g and 8.3 cm, respectively. Average estimated blood loss (EBL) was 192.1 mL; intraoperative and grade 3 postoperative complication rates were 1.4% and 1.6%, respectively. While EBL was significantly higher in obese and morbidly obese patients, this difference was not clinically meaningful, with no significant difference in blood transfusion rates. There were no statistically significant intraoperative or postoperative complication rates across BMI categories. There was a low rate of hospital transfers (0.7%) for all patients.

Conclusion

Laparoscopic-assisted myomectomy can be performed safely in a freestanding ambulatory surgery setting, including morbidly obese patients. This is especially important in the age of COVID-19, as elective surgeries have been postponed due to the 2020 pandemic, which may lead to a dramatic and permanent shift of outpatient surgery from the hospital to the ASC setting.

Authors+Show Affiliations

The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.The Center for Innovative GYN Care, 3206 Tower Oaks Blvd., Suite 200, Rockville, MD 20852 USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32565764

Citation

MacKoul, Paul, et al. "Laparoscopic-assisted Myomectomy With Uterine Artery Occlusion at a Freestanding Ambulatory Surgery Center: a Case Series." Gynecological Surgery, vol. 17, no. 1, 2020, p. 7.
MacKoul P, Danilyants N, Touchan F, et al. Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series. Gynecol Surg. 2020;17(1):7.
MacKoul, P., Danilyants, N., Touchan, F., van der Does, L. Q., Haworth, L. R., & Kazi, N. (2020). Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series. Gynecological Surgery, 17(1), 7. https://doi.org/10.1186/s10397-020-01075-2
MacKoul P, et al. Laparoscopic-assisted Myomectomy With Uterine Artery Occlusion at a Freestanding Ambulatory Surgery Center: a Case Series. Gynecol Surg. 2020;17(1):7. PubMed PMID: 32565764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic-assisted myomectomy with uterine artery occlusion at a freestanding ambulatory surgery center: a case series. AU - MacKoul,Paul, AU - Danilyants,Natalya, AU - Touchan,Faraj, AU - van der Does,Louise Q, AU - Haworth,Leah R, AU - Kazi,Nilofar, Y1 - 2020/06/16/ PY - 2020/01/17/received PY - 2020/06/02/accepted PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline KW - ASC KW - Ambulatory surgery center KW - BMI KW - Freestanding, laparoscopic-assisted myomectomy KW - Ligation KW - Minilaparotomy KW - Morbidly KW - Obese, occlusion SP - 7 EP - 7 JF - Gynecological surgery JO - Gynecol Surg VL - 17 IS - 1 N2 - Background: Non-hysteroscopic myomectomy is infrequently performed in a freestanding ambulatory setting, in part due to risks of intraoperative hemorrhage. There are also concerns about increased surgical risks for morbidly obese patients in this setting. The purpose of this study is to report the surgical outcomes of a series of laparoscopic-assisted myomectomy (LAM) cases at a freestanding ambulatory surgery center (ASC), including a comparative analysis of outcomes in morbidly obese patients (BMI > 40 kg/m2). Methods: A retrospective comparative analysis was performed of 969 women, age 18 years or older, non-pregnant, who underwent LAM by one of two high volume, laparoscopic gynecologic surgical specialists at a freestanding ambulatory surgery center serving the Washington, DC area, between October 2013 and February 2019. Reversible occlusion was performed laparoscopically by placing a latex-based rubber catheter as a tourniquet around the isthmus of the uterus, causing a temporary occlusion of the bilateral uterine arteries. Permanent occlusion was performed laparoscopically via retroperitoneal dissection and uterine artery ligation at the origin of the anterior branch of the internal iliac artery. Minilaparotomy was performed for specimen removal in all cases. No power morcellation was used. Postoperative complications were graded using the Clavien-Dindo Classification system. Outcomes were compared across BMI categories using Pearson Chi-Square. Results: Average myoma weight and size were 422.7 g and 8.3 cm, respectively. Average estimated blood loss (EBL) was 192.1 mL; intraoperative and grade 3 postoperative complication rates were 1.4% and 1.6%, respectively. While EBL was significantly higher in obese and morbidly obese patients, this difference was not clinically meaningful, with no significant difference in blood transfusion rates. There were no statistically significant intraoperative or postoperative complication rates across BMI categories. There was a low rate of hospital transfers (0.7%) for all patients. Conclusion: Laparoscopic-assisted myomectomy can be performed safely in a freestanding ambulatory surgery setting, including morbidly obese patients. This is especially important in the age of COVID-19, as elective surgeries have been postponed due to the 2020 pandemic, which may lead to a dramatic and permanent shift of outpatient surgery from the hospital to the ASC setting. SN - 1613-2076 UR - https://www.unboundmedicine.com/medline/citation/32565764/Laparoscopic-assisted_myomectomy_with_uterine_artery_occlusion_at_a_freestanding_ambulatory_surgery_center:_a_case_series L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32565764/ DB - PRIME DP - Unbound Medicine ER -
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