Frequency and pattern of intrauterine hysteroscopic lesions among women coming for IVF in the city of Yaoundé

Background: Hysteroscopy is an essential tool to make intrauterine assessment in infertile patients. Diagnosis and appropriate correction of intrauterine anomalies are considered essential in order to increase chances of conception. Ourobjective was to determine the frequency and pattern of intra uterine anomalies identified among women attending hysteroscopy at the Gynaecological Endoscopic Surgery and Human Reproduction Teaching Hospital Paul et Chantal Biya ­Yaoundé (GESHRTH). Methodsand results.Thiswas a cross sectional retrospective study of 96 women attending diagnostic or operative hysteroscopy at the GESHRTH between January 2020 and December 2021.The mean age was 38.7 ±7.6 years. Fifty-nine (61.5%) of the patients were nulliparous. Primary and secondary infertility were found respectively in fifty-two patients (54.2%) and forty-four patients (45.4%). Eleven patients (11.5%) were post-menopausal. Concerning previous surgery, 29 patients (30.2%) have had a myomectomy, 28 patients (29.1%) curettage,16 patients (16.6%) laparoscopy, eight (8.3%) hysteroscopy and one (1%) caesarean section. In all, 92 patients (95.8%) had abnormal intra uterine findings consisting of endometrial polyps (43.7%), sub-mucosal fibroids (42.7%), uterine cavity adhesions (20.8%), endometrial atrophy (4.1%), foetal bone (2%), uterine septum (1%) and non-absorbable suture thread (1%).Conclusion: Abnormal uterine findings were identified in 95.8% of patients attending hysteroscopy at GESHRTH. Most frequent findings were polypsin 43.7%, sub-mucosal fibroids in 42.7% and synechiae in 20.8%. The overall per operatory complication rate was 6.2%.

Introduction. Le recours à l'hystéroscopie constitue une étape indispensable au bilan cavitaire des patientes infertiles. Le diagnostic et la prise en charge adéquate des lésions intra cavitaires permettent d'améliorer les chances de conception.L'objectif de cette étude était de déterminer la fréquence et les caractéristiques des anomalies intra cavitaires chez les patientes opérées d'une hystéroscopie au Centre Hospitalier de Recherche et d'Application en Chirurgie Endoscopique et Reproduction Humaine Paul et Chantal Biya ­Yaoundé (CHRACERH).Méthodes et résultats. Nous avons mené une étude descriptive transversale de Janvier 2020 à Décembre 2021 et recruté 96 patientes. L'âge moyen était de38,7 ±7,6 ans. Soixante-neuf patientes (61,5%) étaient nullipares. Cinquante-deux (54,2%) et quarante-quatre (45,5%) présentaient une infertilité primaire et secondaire respectivement. Onze patientes (11,5%) étaient ménopausées. Concernant les antécédents chirurgicaux,nous avons identifié une myomectomie chez 29 patientes (30,2%), un curetage utérin chez 28 (29,1%), une cœlioscopie chez 16 (16,6%), une hystéroscopie chez huit (8,3%) et une césarienne chez une (1%). Au total, 92 (95,8%) des patientes avaient des anomalies cavitaires objectivées. Il s'agissait de polypes endométriaux (43,7%), fibromes sous-muqueux (42,7%), synéchies utérines (20,8%), atrophie de l'endomètre (4,1%), métaplasie osseuse (2%), cloison utérine (1%) et corps étranger à type de fil de suture nonrésorbable (1%).Conclusion.Les anomalies intra-cavitaires étaient retrouvées chez 95,8% des patientes réalisant une hystéroscopie au CHRACERH. Les anomalies les plus représentées étaient les polypes endométriaux (43,7%), les fibromes sous-muqueux (42,7%) et les synéchies utérines (20,8%). Le taux global de complications opératoires était de 6,2%.

Severity of intrauterine adhesions and pregnancy success rates after treatment: Comparison of adhesions obtained from open myomectomy versus uterine curettage

Intrauterine adhesions (IUA) are rare. A retrospective comparative study was conducted between January 1, 2015, and December 31, 2018. Group A comprised 117 women who developed IUAs after open myomectomy, while Group B comprised 113 women who developed IUAs following uterine trauma caused by uterine instrumentation after a termination of pregnancy (TOP) or spontaneous miscarriage. The IUA grade and pregnancy rates and outcomes were compared using the March classification system. All patients underwent hysteroscopic adhesiolysis. The adhesions tended to be more severe (45/117, 38.5%) in Group A than in Group B (29/113, 25.7%); however, this difference was not statistically significant (Chi-Suare 5.047; p = .080). The period of observation was 24 months from the last hysteroscopy. The pregnancy rate in Group A (26, 22.2%) was significantly lower than in Group B (46, 40.7%) (OR: 2.403, 95% CI: 1.352­4.271; p = .003). Open myomectomy was the preceding aetiological factor in a greater proportion of women with IUA in our study. In cases where pregnancy is desired after open myomectomy, especially where the endometrial cavity is breached, postoperative hysteroscopy to exclude IUAs is recommended.

Angioleiomioma uterino: a propósito de un caso / Uterine angioleiomyoma: report of clinical case

Resumen El angioleiomioma es un tumor benigno perivascular que raramente se localiza en el útero. Se expone el caso de un angioleiomioma de gran tamaño en una mujer de 30 años con sangrado menstrual abundante y masa abdominal palpable. La paciente fue sometida a miomectomía y diagnosticada de angioleiomioma por el estudio histológico. Ante síntomas persistentes, la angiomiomectomía o la histerectomía simple son eficaces.

Abstract Angioleiomyoma is a benign perivascular tumor that is rarely located in the uterus. This paper presents a case of a large angioleiomyoma in a 30-year-old woman with heavy menstrual bleeding and a palpable abdominal mass. The patient underwent myomectomy and was diagnosed with angioleiomyoma by histological examination. For persistent symptoms, angiomyomectomy or simple hysterectomy are effective.

Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.

Miomectomía múltiple por vía abdominal / Multiple abdominal myomectomy

RESUMEN Se presentaron dos pacientes a las cuales se les realizó una miomectomía en los meses de enero y marzo de 2017, en la localidad de Luanda, Angola. Ambas fueron atendidas en la consulta de Ginecología por: aumento de volumen del abdomen, sangramiento genital durante la menstruación y fuera de ella, síntomas compresivos caracterizados por urgencia miccional y estreñimiento, además de infertilidad. Se les realizaron: exámenes de laboratorio, ultrasonido ginecológico y renal, así como histerosalpingografía. Después del análisis de estos exámenes se les diagnosticó una miomatosis uterina múltiple; fueron remitidas al salón de operaciones con previo consentimiento informado y se les practicó una miomectomía múltiple sin complicaciones transoperatorias. Se conservó el útero en ambas pacientes, las cuales tuvieron una recuperación postoperatoria satisfactoria. Una de estas pacientes logró un embarazo cinco meses después de la cirugía.

ABSTRACT We present two patients who had a myomectomy in January and March 2017, in Luanda, Angola. Both were treated in the Gynecology consultation due to increased abdominal volume, genital bleeding during and between periods, compressive symptoms characterized by urinary urgency, constipation and infertility. Laboratory tests, gynecological and renal ultrasound, as well as hysterosalpingography were performed. After the analysis of these tests, they were diagnosed with multiple uterine myomas, referred to the operating room with prior informed consent and underwent a multiple myomectomy without transoperative complications. The uterus was preserved in both patients, who had a satisfactory postoperative recovery. One of these patients got pregnant five months after surgery.

Miomectomía en una gestante / Myomectomy in a pregnant woman

Se presenta el caso clínico de una paciente de 27 años de edad con 17,2 semanas de embarazo, quien se encontraba en seguimiento por consulta de Ginecología del Hospital Provincial Ginecoobstétrico Mariana Grajales Coello de Santiago de Cuba por presentar un mioma uterino sintomático con cuadro doloroso abdominal agudo debido a una necrobiosis, lo cual obligó a la resolución quirúrgica urgente. La gestante evolucionó satisfactoriamente y a las 39 semanas se le realizó cesárea, sin complicaciones materno-fetales.

The case report of a 27 years patient with 17.2 weeks of pregnancy is presented, who was in the Gynecology service follow up of Mariana Grajales Coello Gynecoobstetric Provincial Hospital in Santiago de Cuba presenting a symptomatic uterine myoma with acute abdominal pain due to a necrobiosis, which forced an urgent surgical solution. The pregnant woman had a favorable clinical course and a cesarean section was carried out at the 39 weeks of pregnancy without maternal-fetal complications.

The effect of small size uterine fibroids on pregnancy outcomes in high-risk pregnancies

Abstract Objective To evaluate the obstetric outcomes of singleton high-risk pregnancies with a small size uterine fibroid. Methods This retrospective cohort study was conducted among 172 high-risk pregnant women who were followed-up by a single surgeon between 2016 and 2019. Pregnant women with preconceptionally diagnosed small size (< 5 cm) single uterine fibroids (n = 25) were compared with pregnant women without uterine fibroids (n = 147) in terms of obstetric outcomes. Results There was no statistically significant difference between the groups in terms of adverse pregnancy outcomes. The size of the fibroids was increased in 60% of the cases, and the growth percentage of the fibroids was 25% during pregnancy. Intrapartum and short-term complication was not observed in women who underwent cesarean myomectomy. Conclusion Small size uterine fibroids seem to have no adverse effect on pregnancy outcomes even in high-risk pregnancies, and cesarean myomectomy may be safelyperformed in properly selected cases.

Cirurgia robótica em ginecologia: atualidade e perspectivas / Robotic surgery in gynecology: current and perspectives

No ano de 2018, aproximadamente 549.000 cirurgias robóticas em ginecologia foram realizadas no mundo, ocupando o segundo lugar em volume de procedimentos. Estudos sugerem superioridade ou equivalência dessa tecnologia em relação à cirurgia laparoscópica, porém o custo, a disponibilidade e o treinamento limitam sua adoção. Nesta revisão narrativa, os principais benefícios e limitações dos procedimentos ginecológicos robóticos foram analisados. O uso de robôs na histerectomia para o tratamento de lesões benignas apresentou menor incidência de lesões iatrogênicas e de sangramentos em relação à laparoscopia convencional. Na miomectomia robótica, além de menor taxa de complicações, maior volume de miomas retirados foi observado. A cirurgia robótica tem sido bem-sucedida para cirurgias de estadiamento no câncer de endométrio em estágios precoces (I e II), devido à menor taxa de complicações em relação à cirurgia aberta e aos resultados satisfatórios obtidos em mulheres obesas. A histerectomia robótica realizada no tratamento de câncer de colo do útero apresentou menor perda sanguínea em parte dos estudos, porém um ensaio clínico recente demonstrou maior mortalidade no grupo dos procedimentos minimamente invasivos. Espera-se que, com a redução dos custos e a ampliação dos treinamentos, a cirurgia robótica seja uma ferramenta complementar às modalidades já existentes.(AU)

In 2018, 549,000 robotic gynecology surgeries were done in the world, ranking second in volume of procedures. Studies suggest the superiority or equivalence of this technology over laparoscopic surgery, but its cost, availability, and training limit its adoption. In this narrative review, the benefits and limitations of robotic gynecological procedures were investigated. Using robots in hysterectomy for the management of benign lesions showed a lower incidence of iatrogenic lesions and bleeding compared to conventional laparoscopy. In robotic myomectomy, besides a lower complication rate, a larger volume of removed fibroids was noted. Robotic surgery has been successful in the early stages (I and II) endometrial cancer staging surgeries, because of the lower complication rate compared to open surgery and the satisfactory results achieved in obese women. Robotic hysterectomy performed in the treatment of cervical cancer showed less blood loss in part of the studies, but a recent clinical trial showed higher mortality in the minimally invasive procedures group. It is desired that with the reduction of costs and the spread of training robotic surgery will be a complementary tool to existing modalities.(AU)

Factors associated with the complications of hysteroscopic myomectomy / Fatores associados às complicações da miomectomia por histeroscopia

Abstract Objective To evaluate the factors associated with complete myomectomy in a single surgical procedure and the aspects related to the early complications. Methods A cross-sectional study with women with submucous myomas. The dependent variables were the complete myomectomy performed in a single hysteroscopic procedure, and the presence of early complications related to the procedure. Results We identified 338 women who underwent hysteroscopic myomectomy. In 89.05% of the cases, there was a single fibroid to be treated. According to the classification of the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, in French),most fibroids were of grade 0 (66.96%), followed by grade 1 (20.54%), and grade 2 (12.50%). The myomectomies were complete in 63.31% of the cases, and the factors independently associated with complete myomectomy were the diameter of the largest fibroid (prevalence ratio [PR]: 0.97; 95% confidence interval [95%CI]: 0.96-0.98) and the classification 0 of the fibroid according to the FIGO (PR: 2.04; 95%CI: 1.18-3.52). We observed early complications in 13.01% of the hysteroscopic procedures (4.44% presented excessive bleeding during the procedure, 4.14%, uterine perforation, 2.66%, false route, 1.78%, fluid overload, 0.59%, exploratory laparotomy, and 0.3%, postoperative infection). The only independent factor associated with the occurrence of early complications was incomplete myomectomy (PR: 2.77; 95%CI: 1.43-5.38). Conclusions Our results show that hysteroscopic myomectomy may result in up to 13% of complications, and the chance of complete resection is greater in small and completely intracavitary fibroids; women with larger fibroids and with a high degree of myometrial penetration have a greater chance of developing complications from hysteroscopic myomectomy.

Resumo Objetivo Avaliar os fatores associados a miomectomia por histeroscopia completa em um único procedimento e as suas complicações. Métodos Estudo de corte transversal com mulheres submetidas a histeroscopia para exérese de miomas submucosos. As variáveis dependentes foram a miomectomia completa realizada em um tempo cirúrgico único, e a presença de complicações precoces relacionadas ao procedimento. Resultados Analisamos 338 mulheres que foram submetidas a miomectomia histeroscópica. Em 89,05% dos casos, o mioma a ser tratado era único. Quanto à classificação da Federação Internacional de Ginecologia e Obstetrícia (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO, em francês), a maioria era de grau 0 (66,96%), seguidos pelos graus 1 (20,54%) e 2 (12,50%). As miomectomias foram completas em 63,31% das mulheres, sendo que os fatores independentemente associados à miomectomia completa foram o diâmetro do maior mioma (razão de prevalência [RP]: 0,97; intervalo de confiança de 95% [IC95%]: 0,96-0,98) e a classificação FIGO grau 0 (RP: 2,04; IC95%: 1,18-3,52). Foram observadas complicações precoces em 13,01% dos procedimentos (4,44% apresentaram sangramento excessivo durante o procedimento, 4,14%, perfuração uterina, 2,66%, falso pertuito, 1,78%, intoxicação hídrica, 0,59%, laparotomia exploradora, e 0,3%, infecção pósoperatória). O único fator independentemente associado à ocorrência de complicações precoces foi a realização de miomectomia incompleta (RP: 2,77; IC95%: 1,43-5,38). Conclusão Nossos resultados mostram que as complicações da miomectomia por histeroscopia podem ocorrer em até 13% dos procedimentos. A chance de ressecção completa é maior em miomas pequenos e completamente intracavitários; mulheres com miomas maiores e com maior grau de penetração miometrial têm maiores chances de desenvolver complicações.

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.

Miomectomía durante el embarazo / Myomectomy during Pregnancy

Introducción: Los fibromas uterinos, también conocidos como miomas o leiomiomas son los tumores benignos más frecuentes de la porción superior del aparato genital femenino; pueden alcanzar gran tamaño y generalmente no requieren de tratamiento quirúrgico durante el embarazo. La prevalencia del mioma en el embarazo es desconocida. El manejo quirúrgico se reserva solo para los miomas complicados. Objetivo: Mostrar un caso al que se realizó la miomectomía de un gran fibroma suberoso sintomático coexistente con un embarazo de 21 semanas, debido a que no es frecuente su realización en la práctica médica. Presentación de caso: Paciente de 41 años, nulípara, de 21 semanas de gestación, con síntomas compresivos dados por vómitos, molestias digestivas e intolerancia al decúbito supino, afectada por un gran mioma, que fue sometida a miomectomía. La paciente evolucionó satisfactoriamente. Acudió a consultas prenatales cada 15 días hasta las 39,6 semanas, en que se le realizó la cesárea electiva obteniéndose un recién nacido de buen peso y Apgar. Conclusiones: La miomectomía durante el embarazo es un proceder quirúrgico seguro y eficiente con altas tasas de éxito. La discusión del caso es esencial y debe ser realizada por un equipo multidisciplinario, con experiencia probada en cirugía ginecológica(AU)

Introduction: Uterine fibroids, also known as myomas or leiomyomas are the most frequent benign tumors of the upper portion of the female genital tract. They can reach large size and generally do not require surgical treatment during pregnancy. The prevalence of myoma in pregnancy is unknown. Surgical management is reserved only for complicated myomas. Objective: To report a case in which the myomectomy was performed to a large symptomatic suberose fibroid coexisting with a 21-week pregnancy, which is not frequent in medical practice. Case report: A 41-year-old nulliparous patient, 21 weeks pregnant had compressive symptoms due to vomiting, digestive discomfort and intolerance to the supine position. She underwent myomectomy because she was affected by a large myoma. The patient evolved satisfactorily. She was followed up at prenatal consultations every 15 days until 39.6 weeks, when she had an elective caesarean section, resulting a newborn of good weight and Apgar. Conclusions: Myomectomy during pregnancy is a safe and efficient surgical procedure with high success rates. Case discussion is essential and should be carried out by a multidisciplinary team, with proven experience in gynecological surgery(AU)

Robot-assisted surgery in gynecology

The development of robotic technology has facilitated the application of minimally invasive techniques for complex gynecologic surgery. Robot-assisted gynecologic surgery has grown exponentially since receiving Food and Drug Administration approval for use in gynecologic surgery in 2005. Robotic surgery has several major advantages, including three-dimensional visual magnification, articulation beyond normal manipulation, and the filtering of the operator's hand tremors. Therefore, robotic surgery is suitable for microsurgery, and it could be an alternative option for laparotomy. Robotic surgery has advantages, especially for suture-intensive operations such as myomectomy. Patients who underwent robot-assisted laparoscopic myomectomy had significantly decreased estimated blood loss, complication rates, and length of hospital stay. The advantages of robotic surgery help to overcome the limitations of laparoscopy, especially for complicated procedures in deep infiltrating endometriosis. Although extensive radical operations for deep infiltrating endometriosis of the bowel and urinary tract, such as segmental resections of the bladder, ureters, and bowel, were performed by laparotomy in the past, they are now performed more easily and more effectively using robotic techniques. In a recent systematic review and meta-analysis, robotic and laparoscopic sacrocolpopexy resulted in similar clinical outcomes, but robotic surgery was associated with a longer operation time and higher costs. Robotic and conventional laparoscopic hysterectomy show equivalent surgical and clinical outcomes. Compared to laparotomy, robotic gynecologic cancer surgery results in improved clinical outcomes and comparable oncologic outcomes. If robotic surgery is tailored in terms of patient selection, surgeon ability, and equipment availability, it could be a feasible option for highly advanced minimally invasive surgery.

Lack of Haptic Feedback Is Replaced by More Developed Visual Sense during Robotic Myomectomy / 이화의대지

In the reproductive age, many women have several uterine myomas and present with abnormal uterine bleeding, dysmenorrhea, and occasionally infertility. There are three surgical approaches to perform myomectomy, including robotic-assisted, laparoscopic, and abdominal myomectomy. Compared to laparoscopic procedures, robotic myomectomy allows free approach of myoma bases using fine instruments and endoscopes. Fine uterine wall sutures can be performed layer-by-layer with robots. However, robotic surgery is difficult to perform because there is no sense of touch during the operation. We report two clinical myomectomy cases with replaced lack of haptic feedback during robot surgery. The patients received robotic myomectomy with/without right ovarian cystectomy and adhesiolysis. Sixty-five leiomyomas were removed in case 1. Forty-six leiomyomas were removed in case 2. Lack of haptic feedback is replaced by more developed visual sense during robot myomectomy of multiple tiny intramural myomas, and robotic surgery can be performed much more effectively even in complicated cases.

Hysteroscopic myomectomy without anesthesia

OBJECTIVE: Scarce literature about myoma removal without anesthesia has been published. The aim of this paper is to evaluate the feasibility of a new alternative for a hysteroscopic myomectomy in a conventional office setting, without need for anesthesia. METHODS: Step-by-step description of the surgical technique has been provided, based on video images. An office hysteroscopy was performed in a Gynecological Endoscopy Department of a tertiary European hospital. RESULTS: A 49-year-old woman was referred for management of severe hypermenorrhea. Consent and approval were received from the patient and the institutional review board, respectively. The introduction of a Truclear® hysteroscopic polyp morcellator of 5.5 mm with optic of 0 degrees into the uterine cavity did not require any kind of anesthesia or cervical dilatation. The use of saline flow helped distend the cavity and identify a submucosal myoma. Under direct vision, a full myomectomy was performed via mechanical energy with continuous cutting movements, without any complication. After the procedure was completed, the excised material was aspirated through the device into a collecting pouch. A successful complete morcellation of a Type-0 submucosal leiomyoma with a polyp morcellator device was performed in an outpatient setting. Good medical results, good tolerance by the patient besides lower surgical risks due to mechanical instead of electrical energy are shown. CONCLUSION: In conclusion, this video demonstrates that a hysteroscopic myomectomy can be performed successfully in office with lower risk of complications from the procedure and without use of general anesthesia besides good tolerance by the patient.

Safety of pelvic mass extraction through colpotomy in women taken to laparoscopic gynaecologic interventions at Hospital de San José de Bogotá, Colombia, 2016 / Seguridad de la extracción de masas pélvicas por colpotomía en mujeres llevadas a laparoscopia ginecológica en el Hospital de San José de Bogotá, Colombia, 2016

ABSTRACT Objective: To describe the safety of colpotomy in terms of intra- and post-operative complications in women taken to laparoscopy for the removal of benign masses. Materials and methods: Case series of patients with benign adnexal or uterine masses taken to laparoscopic surgery and removal of the specimen through colpotomy. The patients signed the informed consent. Patients with obliterated posterior cul-de-sac, narrow vagina, absence or uterus, deep endometriosis, inflammatory pelvic disease, masses of less than 4 cm, were excluded. Consecutive sampling was used. Sociodemographic, clinical, qualitative and quantitative variables were studied by means of a descriptive analysis of the data. The research study was endorsed by the ethics committee of the institution. Results: During the study period, 12 procedures for the removal of benign pelvic masses using posterior colpotomy were performed. Mean age was 34.3 years (IQR: 29-39,5). Of these cases, 50% were nulliparous women. Mean surgical time was 127 minutes (IQR: 90-150). There were no conversions to laparotomy, and there were no intra- or postoperative complications. Conclusions: Posterior colpotomy is an option that can be considered in the removal of benign pelvic masses of more than 5 cm in size.

RESUMEN Objetivo: Describir la seguridad de la colpotomía en mujeres llevadas a laparoscopia por masas benignas en términos de complicaciones intra y posoperatorias. Materiales y métodos: Serie de casos que incluyó pacientes con masas anexiales o uterinas benignas, sometidas a laparoscopia operatoria con extracción de la pieza quirúrgica mediante colpotomía, previo consentimiento informado. Se excluyeron pacientes con fondo de saco posterior obliterado, vagina estrecha, ausencia de útero, endometriosis profunda, enfermedad inflamatoria pélvica, masas menores de 4 cm, muestreo consecutivo. Se estudiaron variables sociodemográficas, clínicas, cualitativas y cuantitativas mediante un análisis descriptivo. La investigación fue avalada por el comité de ética médica de la institución. Resultados: Durante el periodo de estudio se realizaron 12 extracciones de masas pélvicas benignas por colpotomía posterior. La mediana de la edad fue de 34,3 años (Rango Intercuartílico - RIC: 29-39,5). El 50 % de las pacientes eran nulíparas. La mediana de tiempo quirúrgico fue de 127 minutos (RIC: 90-150). No se realizó ninguna conversión a laparotomía. No se presentaron complicaciones intra ni posoperatorias. Conclusiones: La colpotomía posterior es una alternativa por considerar en la extracción de masas pélvicas benignas cuando tengan un tamaño mayor a 5 cm.

Influence of Duration of Prophylactic Antibiotics Therapy on Uncertainty of Recovery in Elective Laparoscopic Uterine Myomectomy Patients / 기본간호학회지

PURPOSE: The study was done to explore whether the duration of perioperative prophylactic antibiotics therapy influenced uncertainty of recovery in patients with elective laparoscopic uterine myomectomy. METHODS: A prospective study was conducted using self-report questionnaires and electrical medical records for patients with uterine myomectomy. According to the length of the perioperative prophylactic antibiotics therapy, the patients were divided into three groups: single-dose antibiotic treatment group, short-term antibiotic treatment group, and long-term antibiotic treatment group. Data were collected from December 20, 2016 to July 31, 2017 from 161 patients who underwent laparoscopic myomectomy at a metropolitan city general hospital. RESULTS: Level of uncertainty of recovery was 2.98±0.22. The uncertainty was highest in the long-term antibiotic treatment group, followed by the short-term antibiotic treatment group and the single-dose antibiotic treatment group (F=89.40, p < .001). In the regression analysis, factors influencing uncertainty of recovery among uterine myomectomy patients were duration of perioperative prophylactic antibiotic therapy (β=.70, p < .001) and duration of NPO (β=−.11, p=.047) which explained 51.5% of the variance (F=83.75, p < .001). CONCLUSION: Based on these results, information including the administration of antibiotics before surgery should be provided to the patients to help reduce the uncertainty of postoperative recovery.

A Fast 3-Dimensional Magnetic Resonance Imaging Reconstruction for Surgical Planning of Uterine Myomectomy

BACKGROUND: Uterine myoma is the most common benign gynecologic tumor in reproductive-aged women. During myomectomy for women who want to preserve fertility, it is advisable to detect and remove all myomas to decrease the risk of additional surgery. However, finding myomas during surgery is often challenging, especially for deep-seated myomas. Therefore, three-dimensional (3D) preoperative localization of myomas can be helpful for the surgical planning for myomectomy. However, the previously reported manual 3D segmenting method takes too much time and effort for clinical use. The objective of this study was to propose a new method of rapid 3D visualization of uterine myoma using a uterine template. METHODS: Magnetic resonance images were listed according to the slide spacing on each plane of the multiplanar reconstruction, and images that were determined to be myomas were selected by simply scrolling the mouse down. By using the selected images, a 3D grid with a slide spacing interval was constructed and filled on its plane and finally registered to a uterine template. RESULTS: The location of multiple myomas in the uterus was visualized in 3D and this proposed method is over 95% faster than the existing manual-segmentation method. Not only the size and location of the myomas, but also the shortest distance between the uterine surface and the myomas, can be calculated. This technique also enables the surgeon to know the number of total, removed, and remaining myomas on the 3D image. CONCLUSION: This proposed 3D reconstruction method with a uterine template enables faster 3D visualization of myomas.

Is robot-assisted laparoscopic myomectomy limited in multiple myomas?: a feasibility for ten or more myomas

OBJECTIVE: To evaluate the feasibility of robot-assisted laparoscopic myomectomy in multiple myomas over 10. METHODS: A retrospective study was conducted for 662 patients who underwent robot-assisted laparoscopic myomectomy and open myomectomy by a single operator in a tertiary university hospital. RESULTS: A total of 30 women underwent removal of 10 or more uterine myomas by robotics and 13 patients were selected for this study. The average number of myomas removed was 13.7 (range 10–20). The maximum diameter of the myomas was 6.8 cm (range 5.0–10.0 cm). The sum of the diameters of each myoma was 34.7 cm (range 20.0–54.5 cm) and the mass of resected myomas for each case was 229.1 g (range 106.8–437.9 g). In no case was the robotic procedure converted into conventional laparoscopy or laparotomy, and all patients recovered without any major complications. In comparison with 13 cases of open myomectomy during the same period, robotic surgery took longer time than open surgery (360.5 vs. 183.8 minutes; P=0.001) but had shorter postoperative hospital days after surgery (mean 2.5 vs. 3.5 days; P=0.003). CONCLUSION: Robot-assisted laparoscopic myomectomy could be an alternative to laparotomic myomectomy for numerous myomas over 10 in number.

Successfully removed uterine angioleiomyoma by robot-assisted laparoscopic myomectomy

Angioleiomyoma is a rare type of leiomyoma variant and there are a few cases reported to date. Herein, we present a case of angioleiomyoma in a 36-year-old woman with lower abdominal pain, initially diagnosed by degenerated uterine leiomyoma. The transvaginal ultrasonogram showed an ovoid-shaped heterogeneously hyperechoic lesion in left cornual site of uterus and pelvic magnetic resonance image showed an about 5.1 cm sized heterogenous T2 intermediate high mass with poor enhancement. The patient underwent a robot-assisted laparoscopic myomectomy, and final histopathologic diagnosis revealed uterine angioleiomyoma. This case is the first case of angioleiomyoma resected by robotic surgery. The patient is on follow up for over 1 year and shows no evidence of recurrence until now.

TeleCondutas: sangramento uterino anormal / TeleGuides: abnormal uterine bleeding

Sangramento uterino anormal (SUA) é caracterizado por diferentes padrões de sangramento menstrual que variam de alteração no volume, irregularidades na duração e no ciclo menstrual. A condição costuma impactar na qualidade de vida das mulheres, sendo um problema de saúde frequente no atendimento da Atenção Primária à Saúde, acometendo cerca de 10% das mulheres em idade reprodutiva. As principais causas do sangramento uterino anormal são disfunções ovulatórias, gravidez, anormalidades estruturais, distúrbios de coagulação e causas iatrogênicas. Esta guia apresenta informação que orienta a conduta para casos de sangramento uterino anormal no contexto da Atenção Primária à Saúde, incluindo: classificação, etiologias de SUA por faixa etária, avaliação diagnóstica, tratamento, encaminhamento para serviço especializado.