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Vol. 68, No. 2, 2009
Issue release date: August 2009
Section title: Original Article
Gynecol Obstet Invest 2009;68:127–133
(DOI:10.1159/000227764)

Ultra-Minilaparotomy Myomectomy: A Minimally Invasive Surgical Approach for the Treatment of Large Uterine Myomas

Ciavattini A. · Tsiroglou D. · Litta P. · Frizzo H. · Tranquilli A.L.
aDepartment of Obstetrics and Gynecology, Università Politecnica delle Marche, Ancona, and bDepartment of Gynecological Sciences and Human Reproduction, Padua University, Padua, Italy

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Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: 6/18/2008
Accepted: 1/15/2009
Published online: 7/8/2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: http://www.karger.com/GOI

Abstract

Background: In recent years, a growing number of more conservative methods for the treatment of uterine myomas has been reported. However, only a small number of techniques is used for the treatment of large myomas. Aims: In the present retrospective study, we report our experience with a group of patients who consecutively underwent ultra-minilaparotomy myomectomy for single or multiple large myomas, with diameter greater than 5 cm, with emphasis on the safety and efficacy of this procedure. Methods: Forty-one women underwent an ultra-minilaparotomy myomectomy that involved a <4 cm transverse skin incision, with or without laparoscopic assistance. Results: Mean operating time was 92.4 min, the mean hemoglobin decline was 2.0 g/dl and the mean hematocrit decline was 5.7%. The mean time to discharge was 84.3 h. No patient underwent a second surgery for early postoperative complications. Postoperative fever occurred in 4 patients, especially in patients who underwent ultra-minilaparotomy without assisted laparoscopy. There were two cases of severe anemia with recourse to blood transfusion. Conclusion: The results of this study suggest that ultra-minilaparotomy myomectomy with or without laparoscopic assistance might represent a safe and effective minimally invasive alternative to standard open myomectomy in the treatment of large myomas.


Article / Publication Details

First-Page Preview
Abstract of Original Article

Received: 6/18/2008
Accepted: 1/15/2009
Published online: 7/8/2009

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 3

ISSN: 0378-7346 (Print)
eISSN: 1423-002X (Online)

For additional information: http://www.karger.com/GOI


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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References

  1. Cramer DW: Epidemiology of myomas. Semin Reprod Endocrinol 1992;10:320–324.

    External Resources

  2. Buttram VC Jr, Reiter RC: Uterine leiomyomata: etiology, symptomatology and management. Fertil Steril 1981;36:433–445.
  3. Guarnaccia M, Rein M: Traditional surgical approaches to uterine fibroids: abdominal myomectomy and hysterectomy. Clin Obstet Gynecol 2001;44:385–400.
  4. ACOG Committee on Practice Bulletins-Gynecology: ACOG practice bulletin. Surgical alternatives to hysterectomy in the management of leiomyomas. Number 16, May 2000 (replaces educational bulletin number 192, May 1994). Int J Gynaecol Obstet 2001;73:285–293.
  5. Hills SD, Marchbanks PA, Peterson HB: Uterine size and risk of complication among women undergoing abdominal hysterectomy for leiomyomas. Obstet Gynecol 1996;87:539–543.
  6. Damiani G, Campo S, Dargenio R: Laparoscopic vs. laparotomic ovarian cystectomy in reproductive age women: an economic evaluation. Gynecol Endosc 1998;7:19–23.

    External Resources

  7. Nezhat F, Nezhat C, Gordon S, Wilkins E: Laparoscopic versus abdominal hysterectomy. J Reprod Med 1992;37:247–250.
  8. Darai E, Deval B, Darles C, et al: Myomectomy: laparoscopy or laparotomy. Contracept Fertil Sex 1996;24:751–756.
  9. Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C: Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod 2001;16:1726–1731.
  10. Glasser MH: Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol 2005;12:275–283.
  11. Nezhat C, Nezhat F, Bess O, Nezhat CH, Mashiach R: Laparoscopically assisted myomectomy: a report of a new technique in 57 cases. Int J Fertil Menopausal Stud 1994;39:39–44.
  12. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N: Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 2006;13:92–97.
  13. Cagnacci A, Pirillo D, Malmusi S, Arangino S, Alessandrini C, Volpe A: Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study. Hum Reprod 2003;18:2590–2594.
  14. Adamyan LV: Minimally invasive surgery in gynaecologic practice. Int J Obstet Gynecol 2003;82:347–355.
  15. Meeks R: Advanced laparoscopic gynaecologic surgery. Surg Clin North Am 2000;80:1443–1464.
  16. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB: Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 1996;174:654–658.
  17. Tulandi T, Murray C, Guralnick M: Adhesion formation and reproductive outcome after myomectomy and second-look laparoscopy. Obstet Gynecol 1993;82:213–215.
  18. Discepola F, Valenti DA, Reinhold C, Tulandi T: Analysis of arterial blood vessels surrounding the myoma relevance to myomectomy. Obstet Gynecol 2007;110:1301–1303.
  19. Dubuisson JB, Fauconnier A, Babaki-Fard K, Chapron C: Laparoscopic myomectomy: a current view. Human Reprod Update 2000;5:588–594.

    External Resources

  20. Dubuisson JB, Chapron C, Chavet X, Gregorakis SS: Fertility after laparoscopic myomectomy of large intramural myomas: preliminary results. Hum Reprod 1996;11:518–522.
  21. Seinera P, Arisio R, Decko A, Farina C, Crana F: Laparoscopic myomectomy: indications, surgical technique and complications. Hum Reprod 1997;12:1927–1930.
  22. Pelosi MA 3rd, Pelosi MA: Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy. Am J Obstet Gynecol 1997;177:1547–1549.
  23. Hasbargen U, Summerer-Moustaki M, Hillemanns P, Scheidler J, Kimmig R, Hepp H: Uterine dehiscence in a nullipara, diagnosed by MRI, following use of unipolar electrocautery during laparoscopic myomectomy: case report. Hum Reprod 2002;17:2180–2182.
  24. Lieng M, Istre O, Langebrekke A: Uterine rupture after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc 2004;11:92–93.
  25. Seracchioli R, Colombo FM, Bagnoli A, Govoni F, Missiroli S, Venturoli S: Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure? BJOG 2003;110:236–240.
  26. Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A: Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 2001;16:770–774.
  27. Benedetti-Panici P, Maneschi F, Cutillo G, Scambia G, Congiu M, Mancuso S: Surgery by minilaparotomy in benign gynecological disease. Obstet Gynecol 1996;87:456–459.
  28. Srivastava A, Srinivas G, Misra MC, Pandav CS, Seenu V, Goyal A: Cost-effectiveness analysis of laparoscopic versus minilaparotomy cholecystectomy for gallstone disease. Int J Technol Assess Health Care 2001;17:497–502.
  29. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C: Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 2000;15:2663–2668.
  30. Friedmann W, Maier RF, Luttkus A, Schafer AP, Dudenhausen JW: Uterine rupture after laparoscopic myomectomy. Acta Obstet Et Gynecol Scand 1996;75:683–684.
  31. Seidman DS, Nezhat CH, Nezhat F, Nezhat C: The role of laparoscopically assisted myomectomy (LAM). JSLS 2001;5:299–303.
  32. Fanfani F, Fagotti A, Bifulco G, Ercoli A, Malzoni M, Scambia G: A prospective study of laparoscopy versus minilaparotomy in the treatment of uterine myomas. J Minim Invasive Gynecol 2005;12:470–474.
  33. Darai E, Dechaud H, Benifla JL, Renolleau C, Panel P, Madelenat P: Fertility after laparoscopic myomectomy: preliminary results. Hum Reprod 1997;12:1931–1934.