Clinical effect of transvaginal and laparoscopic myomectomy / 中国医师进修杂志

Objective:To explore the clinical effect of transvaginal and laparoscopic myomectomy.Methods:A total of 40 cases treated with hysteromyomectomy in Xinhua Hospital Affiliated to Dalian University and Dalian Women′s and Children′s Medical Center from Decedmber 2018 to March 2020 were selected as the research objects. According to the random number table method, they were assigned into the observation group (20 cases) and the control group (20 cases). In the observation group, hysteromyomectomy was performed via vagina, and in the control group, hysteromyomectomy was performed via laparoscope. Then the time of operation, the amount of bleeding, the recovery time of gastrointestinal function, 24 h postoperative drainage, 12 h postoperative pain and hospitalization expenses were compared between the two groups.Results:The operation of the observation group and the control group were completed as planned. The operation time, the amount of bleeding of the observation groupwere less than those of the control group: (69.75 ± 19.43) min vs. (84.50 ± 22.4) min, (119.25 ± 56.37) ml vs. (159.00 ± 63.73) ml, the differences were statistically significant ( P<0.05). The recovery time of gastrointestinal function, 24 h postoperative drainage, 12 h postoperative pain in two groups had no significant differences ( P>0.05). The hospitalization expenses in observation group was lower than that in control group: (2.27 ± 0.12) ten thousand Yuan vs. (2.66 ± 0.10) ten thousand Yuan, the difference was statistically significant ( P<0.05). Conclusions:Compared with laparoscopic myomectomy, transvaginal myomectomy has the advantages of shorter operation time, less bleeding and less hospitalization expenses.

Laparoscopic versus laparoscopically-assisted myomectomy: An institutional experience / Philippine Journal of Obstetrics and Gynecology

Background@#Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach.@*Objectives@#This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital.@*Methods@#This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017.@*Results@#There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant.@* Conclusions@#The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.

Long-term outcomes of single-port laparoscopic myomectomy using a modified suture technique

OBJECTIVE: To evaluate the long-term outcomes, including the pregnancy outcome and recurrence rate after single-port laparoscopic myomectomy (LM) using a modified suture technique with a Hem-o-lok clip (Choi's LM) and conventional 4-port LM.METHODS: A retrospective study of patients who underwent Choi's LM (n=55) and 4-port LM (n=102) in a single institutional hospital was conducted. Patients with <3 symptomatic myomas sized <10 cm each and operated on by a single surgeon were included. Recurrence was confirmed when a myoma measuring ≥3 cm was detected.RESULTS: The patients in both groups had similar demographic characteristics. Single (76.4% vs. 62.7%) and intramural (52.7% vs. 56.9%) tumors were commonly detected in both groups in the mean diameter (6.8±1.5 cm vs. 7.0±1.6 cm; P=0.40). In Choi's LM, 16 patients (29.1%) needed an additional port; those who were nulliparous and/or had a large leiomyoma more frequently required an additional port (P=0.023 and 0.04, respectively). During a median follow-up period of 69 months, 17 patients (7.1% vs. 14.6%) had recurrence. The size of dominant myomas at recurrence was significantly smaller in patients who underwent Choi's LM (3.4±0.7 cm vs. 5.7±2.4 cm; P=0.004). All 13 patients in both groups who successfully conceived had a full-term delivery. No major complications occurred during pregnancy.CONCLUSION: Although an additional port was frequently used, the long-term outcomes of patients who experienced recurrence and pregnancy after Choi's LM were acceptable. Considering its usability, Choi's LM is feasible for the treatment of uterine leiomyoma.

Miomectomía por laparoscopia con extracción por colpotomía posterior: reporte de tres casos / Laparoscopic myomectomy with extraction by posterior colpotomy: Report of three cases

Resumen ANTECEDENTES La extracción de un mioma, posterior a la resección laparoscópica, puede ser: directa, mediante colpotomía posterior, minilaparotomía, morcelación intraabdominal estándar o eléctrica. La mayor parte de estas opciones suele requerir la colocación de un trocar de 10-12 mm o la ampliación de la incisión en la piel y fascia para extraer el tejido; esto implica desventajas estéticas y clínicas, como el riesgo de hernias incisionales. CASOS CLÍNICOS Se comunican tres casos de pacientes con diagnóstico de miomatosis de grandes elementos (7 cm el menor y 15 cm el mayor) en los que posterior a la miomectomía por laparoscopia se extrae la pieza quirúrgica íntegra mediante colpotomía posterior, con evolución posquirúrgica favorable y sin síntomas concomitantes. CONCLUSIÓN La extracción transvaginal mediante colpotomía posterior es una alternativa segura y efectiva para retirar piezas quirúrgicas porque la elasticidad de la vagina permite extraer de forma segura piezas grandes, y evitar así el uso del morcelador y sus posibles riesgos. Además, se evita ampliar las incisiones abdominales, lo que implica menor dolor posoperatorio, recuperación más rápida y mejores resultados cosméticos. La vía vaginal es segura, con mínimo riesgo de complicaciones y con mejores resultados posquirúrgicos comparada con el resto de las opciones de cirugía laparoscópica.

Abstract BACKGROUND The extraction of the myoma after laparoscopic resection can be done by: direct extraction, standard intra-abdominal morcellation, electric morcellation, extraction by posterior colpotomy or by minilaparotomy. Most of these options generally require placement of a 10-12 mm trocar and / or enlargement of the skin incision and fascia for tissue removal; In addition to the aesthetic disadvantages, it represents clinical implications such as the risk of incisional hernias. CLINICAL CASES We present 3 cases of patients with diagnosis of myomatosis of large elements, the smallest being 7 cm and the largest being 15 cm, in greater diameter, after the laparoscopic myomectomy the extraction of the complete surgical piece is performed through posterior colpotomy, presenting a favorable postoperative recovery, without associated symptoms. CONCLUSIONS The transvaginal extraction through posterior colpotomy represents a safe and effective alternative for the extraction of surgical pieces, the elasticity of the vagina allows the safe extraction of large pieces, avoiding the use of the morcellator and its possible risks; It also avoids expanding the abdominal incisions, associating to less postoperative pain, faster recovery and better cosmetic results. The vaginal route is a safe option with minimal risk of complications, and with better postsurgical results compared to the other options in laparoscopic surgery.

Comparison on gravidity of post-operative patients between uterine fibroid ablation of high intensity focused ultrasound and laparoscopic myomectomy / 中国医学装备

Objective: To compare the effects between uterine fibroid ablation of high intensity focused ultrasound (HIFU) and laparoscopic myomectomy for gravidity of postoperative patients. Methods: 120 patients with uterine fibroid were divided into ultrasound ablation group (60 cases) and laparoscopy group (60 cases) as random number table. And the patients of ultrasound ablation group were treated by using HIFU and the patients of laparoscopy group received the treatment of laparoscopic myomectomy. The operative situation, curative effect and post-operative situation of gravidity of the two groups were compared and researched. Results: The effective rate of laparoscopy group was significantly higher than that of ultrasound ablation group (x2=3.56, P<0.05), while operation time, bleeding volume and postoperative recovery time of laparoscopy group were significantly higher than that of ultrasound ablation group, respectively (t=1.560, t=1.975, t=1.896, P<0.05). On the other hand, the postoperative gravidity rate of ultrasound ablation group was significantly higher than that of laparoscopy group (x2=3.65, P<0.05). Conclusion:Although the effective rate of HIFU for ablation of uterine fibroids is lower than that of laparoscopic myomectomy, its recovery time is shorter and its postoperative gravidity rate is higher than that of laparoscopic myomectomy. Therefore, it has popularized worthy in clinical practice.

Clinical observation of laparoscopic myomectomy combined with preoperative GnRH-a in treating leiomyoma with large uterus / 中国内镜杂志

Objective To evaluate the curative effect of laparoscopic myomectomy combined with preoperative gonadotropin releasing hormone agonists (GnRH-a) in treating myoma patients with uterus volume large than 12 weeks of pregnancy size. Methods 46 patients with uterine volume over 12 gestational weeks from August 2009 to August 2016 were selected as research objects. Leuprolide was injected subcutaneously for three to six times, and then laparoscopic myomectomy was performed one month later. The changes of volumes in uterus and myoma before and after medication were observed as well as the changes of hemoglobin. And postoperative recurrence of uterus myoma was followed up. Results The average volume of the uterus in the 46 patients, detected by B ultrasound, before GnRH-a treatment was (705.47 ± 282.37) cm3, and the average volume of the uterus after GnRH-a treatment was (331.95 ± 84.53) cm3, which was shortened by 59.35%, with significant difference (P < 0.05). The volume of uterus myoma was (237.59 ± 138.46) cm3 before GnRH-a treatment and (81.59 ± 46.44) cm3 after GnRH-a treatment, shortened by 65.66%, with significant difference (P < 0.05). The hemoglobin value was (97.80 ± 20.19) g/L before GnRH-a and (119.63 ± 12.06) g/L after GnRH-a treatment, with significant difference (P < 0.05). Follow-up for 3 weeks to 5 years, the surgeries were accomplished successfully, and no case was transferred to laparotomy. Conclusion Preoperative GnRH-a could shorten volume of uterus myoma, increase hemoglobin value and ensure performance of laparoscopic myomectomy for myoma patients with uterus volume large than 12 weeks of pregnancy size.

Hybrid laparoscopic myomectomy: A novel technique

The objective of this study was to report on a new surgical technique, hybrid laparoscopic myomectomy that integrates the advantages of transumbilical laparoendoscopic single-site surgery and those of isobaric laparoscopy, and the initial experience with 14 cases. All of the procedures were performed by a single surgeon who has over 18 years of experience in laparoscopic surgery and 4 years of experience in laparoendoscopic single-site surgery. All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure. The median operative time was 75 minutes (range, 30 to 100 minutes). No postoperative complication was observed. The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

Investigation of the anaesthetic effect of propofol combined with remifentanil by target-controlled infusion during gynecological laparoscopic myomectomy / 中国综合临床

Objective To investigate the anaesthetic effect of propofol combined with remifentanil by target-controlled infusion (TCI) used in gynecological laparoscopic myomectomy.Methods Fifty cases,who were scheduled for gynecological laparoscopic myomectomy in our hospital from June 2010 to June 2011,was randomly divided into propofol combined with remifentanil group (n =25) and inhalation anesthesia (remifentanil combined with sevoflurane) group (n =25).The heart rate and blood pressure were recorded at the time of before induction of anesthesia (T0),30 min after carbon dioxide pneumoperitoneum,the end of operation and 3 min after extubation.The awake time,time of extubation and surgery time were also recorded.Results The hemodynamics were kept stable in propofol combined with remifentanil group,and there were no significant difference with respect to SABP,DABP and heart rate at all time points compared with baseline (P ＞0.05) in propofol group.However,in inhalation anesthesia group,SABP,DABP and heart rate were increased significantly at 30 min after carbon dioxide pneumoperitoneum and 3 min after extubation when compared with baseline (P ＜ 0.05) and were higher than those of propofol group (P ＜ 0.05) at counterpart time points.In inhalation anesthesia group,the awake time ((9.3 ± 1.5) min vs (4.9 ± 1.1) min,t =10.56,P =0.017) and time of extubation ((12.9 ± 2.4) min vs.(6.8 ± 1.2) min,t =12.36,P =0.01) were significantlv longer than that of propofol group (P ＜ 0.05).Conclusion Propofol combined with remifentanil TCI-based anesthesia could achieve the optimal hemdynamic stability during anesthesia maintance and better recovery profile from anesthesia in gynecological laparoscopic myomectomy.

Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach

OBJECTIVE: To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. METHODS: A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. RESULTS: Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. CONCLUSION: Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.

Perioperative comparisons of the laparoscopic myomectomy and laparoscopically assisted myomectomy in women with symptomatic uterine myoma / 대한산부인과내시경학회지

OBJECTIVE: This study was conducted to compare the perioperative outcomes in patients with symptomatic uterine myoma who underwent laparoscopic (LM) or laparoscopically assisted myomectomy (LAM). METHODS: A total of 207 patients with myoma underwent LM or LAM in Samsung Medical Center between October 2006 and March 2010. Of them, 121 patients with LM and 50 with LAM met the inclusion criteria and were compared for the perioperative outcomes. RESULTS: The operation time was significantly shorter in the LAM group than in the LM group (111 min versus 139 min; p<.001, respectively). Estimated blood loss was significantly higher in the LAM group (p<.001). Intraoperative, early postoperative complications, hospitalization days and postoperative analgesics use were similar between the 2 study groups. CONCLUSION: LM and LAM is comparable in the perioperative outcomes in patients with symptomatic uterine myoma.

The actual circumstances of blood loss in the laparoscopic myomectomy: Anemia after laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: This study was designed to assess the actual circumstances of post-operative anemia and associating factors, during the laparoscopic myomectomy. METHODS: A retrospective chart review of 172 patients who underwent laparoscopic myomectomy from 2008 to 2009 was performed. Characteristics of patients (age, parity, body mass index, and preoperative gonadotropin releasing hormone agonists injection) and fibroids (the largest diameter, number, width, type and location), and surgical outcomes (operating time, pre- and post-operative hemoglobin level, blood loss, hospital stay, and complications, including transfusion) were retrieved. RESULTS: One patient (0.6 %) required transfusion and significant hemoglobin change (> or =2.0 g/dL) occurred in 45 patients, after laparoscopic myomectomy. The largest diameter, width, type, and location of fibroids, and pre-operative gonadotropin releasing hormone agonist injection were not associated with the hemoglobin change (p=0.193, 0.172, 0.764, 0.741, and 0.954 respectively). Multivariate analysis revealed that nulliparity (p=0.195, 95% confidence interval (CI): 0.286-1.291) was not a risk factor, but long operating time (> or =90 min; p=0.048, 95% CI: 1.008-5.054) and multiple myoma (> or =3 in number; p=0.009, 95% CI: 1.320-6.717) were independent risk factors for significant hemoglobin change. CONCLUSION: In our data, symptomatic anemia after laparoscopic myomectomy was uncommon. In addition, the only useful predictive factor for hemoglobin change during the laparoscopic myomectomy was a multiplicity of myoma.

Clinical efficacy review on cases of laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: To report the safety and clinical efficacy of laparoscopic myomectomy. METHODS: We analyzed retrospectively the data for 74 laparoscopic myomectomy performed at Inje University Busan Paik Hospital beween 2005 and 2009. With medical records, we analyzed data on the patient's age, parity, BMI, size, weight and location of myoma, previous operative history, preoperative indication, operating time, blood loss, change of hemoglobin concentration from preoperative to postoperative state, hospital stay. RESULTS: The mean age of the patients was 39.5+/-6.9 years, parity was 1.4+/-1.0 and BMI was 22.1+/-2.6 kg/m2. The size of myoma by preoperative ultrasonography was 5.2+/-1.9 cm, the weight of removed myoma was 95.1+/-88.1 g. Most myomas were subserosal and intramural type. The operating time was 95.9+/-34.4 minutes, the change of hemoglobin concentration was 1.3+/-0.78 g/dL, and the hospital stay was 4.7+/-1.1 days. Postoperatively, transfusion was done in 2 cases, one patient was pregnant and underwent an cesarean section delivery during follow-up. CONCLUSION: Laparoscopic myomectomy was performed regardless of the size, the location of the myoma or the previous operative history and had good outcomes without complications in our hospital. Laparosocpic myomectomy is considered safe and reliable procedure in various types of myoma.

Single port access laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: The aim of this study was to estimate the feasibility, safety and surgical outcomes of single port access laparoscopic myomectomy (SPA-M). METHODS: We reviewed the medical records of 29 patients with uterine leiomyoma who underwent SPA-M in Gumi CHA hospital between March 2010 and August 2010. We performed SPA-M with conventional rigid straight laparoscopic instruments in all cases. RESULTS: In this study, the mean of leiomyoma weight, operating time, and estimated blood loss were 55.43 gm(+/-54.79, range 5~220 gm), 69.68 min (+/-32.99, range 20~120 min.), 100 mL (+/-104.26 range minimal~300 mL), respectively. Transfusion was done in the one case. CONCLUSION: SPA-M using conventional rigid straight laparoscopic instruments was feasible and could be an alternative to conventional multi-port access laparoscopic myomectomy (MPA-M).

The effectiveness of a single preoperative dose of misoprostol during laparoscopic myomectomy / 대한산부인과내시경학회지

OBJECTIVE: To evaluate the effectiveness of single preoperative dose of misoprostol to reduce intraoperative hemorrhage during laparoscopic myomectomy. METHODS: We reviewed retrospectively the medical records of 148 patients who underwent laparoscopic myomectomy in Gangnam CHA Medical Center between January 2007 and December 2009 by single surgeon. Among them, 46 patients used preoperative transrectal misoprostol. One hundred two patients underwent laparoscopic myomectomy in conventional method without any preoperative agents. RESULTS: The two groups were similar in baseline characteristics. There was no significant difference in mean blood loss (misoprostol group: 203.3+/-181.8 mL vs. no agent group: 207.7+/-144.5 mL), operation time (misoprostol group: 113.3+/-28.2 min vs. no agent group: 113.4+/-31.5 min), and hemoglobin change (misoprostol group: 2.0+/-1.0 g/dL vs. no agent group: 1.9+/-1.0 g/dL). Two patients needed transfusion in misoprostol group whereas none in control group, but there was no statistical significance. CONCLUSION: A single preoperative dose of transrectal misoprostol cannot reduce bleeding during laparoscopic myomectomy.

Study for the clinical efficacy of laparoscopic myomectomy / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the safety and the clinical efficacy of the laparoscopic myomectomy through analyzing several operation factors. METHODS: There were 185 cases of laparoscopic myomectomy between January 2004 and December 2008 at the department of obstetrics and gynecology in Hanyang University Guri Hospital. Retrospectively many factors of the operation were analyzed. The factors include the size, number and type of the myoma, BMI (body mass index), operation method, operation time, and complication and the prognosis of the operation. RESULTS: For the type of myomas, 115 (62.2%) cases were intramural myomas, 38 (20.5%) cases were subserosal types and 32 (17.3%) cases were mixed types. The average diameter of the biggest myoma was 6.67+/-0.16 cm (range, 2.5~15 cm) and the average number of the myoma was 2.07+/-0.15 (range, 1~15). Previous operation history and pelvic adhesion did not show correlation with the operation time. The size, type and number of myoma and the operation methods showed correlation with the operation time. According to myoma size and number, we divided the cases into two groups, low risk group (122 cases) and high risk group (63 cases). The analysis showed that post-operation hemoglobin drop (2.89+/-0.10 g/dL vs. 4.03+/-0.23 g/dL) and blood transfusion amount (2.89+/-0.10 pints vs. 4.03+/-0.23 pints) as well as the operation time (137.58+/-4.37 min vs. 193.73+/-9.88 min) showed noticeable increase in the high risk group. CONCLUSION: This statistics show that laparoscopic myomectomy is now being applied to patients with larger and more myomas. Factors affecting operation time were the weight of myomas, number of myomas, type of myomas, number of trocars and methods of resected myomas removal. Also, operation time and post-operative hemoglobin drop increased in the high risk group.

A case of leiomyomatosis peritonealis disseminata arising after laparoscopic myomectomy / 대한산부인과학회지

Leiomyomatosis peritonealis disseminata (LPD) is rare, typically benign condition characterized by multiple smooth muscle, myofibroblasticand fibroblastic nodules arising in the pelvic and abdominal cavities in women. LPD is observed in reproductive age group especially and often mimics carcinomatosis grossly but has benign histologic feature and good prognosis. We report a case of leiomyomatosis peritonealis disseminata arising after laparoscopic myomectomy with review of literature.

Update in Laparoscopic Hysterectomy and Laparoscopic Myomectomy / 한양의대학술지

The role of laparoscopic hysterectomy (LH) in current gynecological practice has yet to be defined. Randomized trials have demonstrated that, compared to abdominal hysterectomy, LH shortens hospital stay and induces less postoperative pain and quicker recovery. Some retrospective publications it seems that complication rates have increased in LH, especially those involving the urinary system. However, a recent analysis revealed a reasonable complication rate for the procedure, compared with abdominal hysterectomy, Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive procedure that was developed during the 1990s as a treatment for abnormal uterine bleeding. The literature regarding this procedure, mainly case series and retrospective comparisons, suggests that LSH results in reduced operating time and blood loss and a quicker return to normal activity, compared with laparoscopic-assisted vaginal hysterectomy (LAVH). Given the lack of appropriate randomized, controlled trials and the limitations of the existing research, the LSH's true value and appropriate clinical indications remain unknown Uterine fibroids are the most common benign tumors of the uterus. Management depends on the symptoms, location and size of the fibroids, and the patient's desire to conceive. Surgical management of uterine fibroids has changed from laparotomy to minimally invasive surgery. Advances in surgical instruments and techniques are expanding the role of laparoscopic myomectomy in well-selected ndividuals. Meticulous repair of the myometrium is essential for women considering pregnancy after laparoscopic myomectomy to minimize the risk of uterine rupture. Laparoscopic myomectomy is an appropriate alternative to abdominal myomectomy or hysterectomy.

Clinical efficacy of laparoscopic myomectomy for 110 cases of various sized myomas / 대한산부인과학회지

OBJECTIVE: To assess the feasibility and clinical efficacy of laparoscopic myomectomy (LM). METHODS: We analyzed retrospectively the data for 110 LM preformed at Kangbuk Samsung Hospital between July 2003 and July 2006. We reviewed their clinical charts and the operative and anesthetic records, and analyzed data on the patients' age, parity, previous operative history, preoperative indication, the diameter of the largest myoma, operating time, number of the removed myoma, hospital stay, change of the hemoglobin concentration from preoperative to postoperative day 1, concomitant procedures, histopathological reports, and complications. RESULTS: The mean age of the patients was 35.7+/-5.8 years, the mean parity was 0.8+/-0.9, and 26 (23%) patients had a previous operative history. The most common operative indication was a palpable abdominal mass (46 patients, 41.9%), followed by chronic pelvic pain (32 patients, 29.0%), abnormal uterine bleeding (24 patients, 21.8%), urinary frequency (7 patients, 6.4%), and infertility (1 patient, 0.9%). The mean operating time was 82.9+/-30.8 minutes, and the mean diameter of the largest myoma was 7.1+/-2.3 cm. The heaviest of the removed myoma weighed 795 gm. The mean change of the hemoglobin concentration was 2.2+/-1.1 g/dL, and the mean hospital stay was 3.5+/-1.4 days. Postoperatively, transfusions were done 10% (11 cases) of patients, and 2 cases of paralytic ileus and a case of subcutaneous emphysema were noted. Conversion rate to laparotomy was 0.9% (1 case). CONCLUSION: LM for various sized myomas can be performed successfully and effectively by decreasing laparoconversion, if the surgical team and the laparoscopic surgeon are experienced and enhanced equipment is available.

Laparoscopic Myomectomy for Large Myomas

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9+/-5.6 yr, mean parity was 0.6+/-0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6+/-38.9 min, and the mean diameter of the largest myoma was 9.3+/-1.8 cm. The mean change in hemoglobin concentration was 2.1+/-1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.

Spontaneous uterine rupture in a patient who had previously undergone laparoscopic myomectomy (Case report).

Following laparoscopic myomectomy, uterine rupture during pregnancy or delivery in the area of the scar is a very rare but dangerous complication. Individual cases of uterine rupture during pregnancy are described in the literature. Case report of uterine rupture during delivery in a patient who had previously undergone laparoscopic myomectomy. In the case presented here, the patient conceived 6 months after an 3.5 cm intramural myoma, had been laparoscopically removed. No symptoms suggesting uterine rupture were observed during the pregnancy, but in the first stage of delivery the condition of the patient deteriorated and symptoms of oligaemic shock developed. A laparotomy was performed, which showed the presence of 2100 gr fresh dead fetus in the abdominal cavity and ruptured uterine muscle in the scarred area about 5 cm. In patients who have previously undergone a laparoscopic myomectomy, there is some risk of uterine rupture at delivery. This is also the case where unappropriate suturing of the uterine muscle had been required.