World Journal of Laparoscopic Surgery

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VOLUME 6 , ISSUE 2 ( May-August, 2013 ) > List of Articles

RESEARCH ARTICLE

Laparoscopic Myomectomy for Large Fibroids with Synchronized use of Uterine Artery Embolization

MW Kamran, TK Madhuri, WJ Walker, SA Butler-Manuel

Citation Information : Kamran M, Madhuri T, Walker W, Butler-Manuel S. Laparoscopic Myomectomy for Large Fibroids with Synchronized use of Uterine Artery Embolization. World J Lap Surg 2013; 6 (2):107-110.

DOI: 10.5005/jp-journals-10033-1193

Published Online: 01-04-2016

Copyright Statement:  Copyright © 2013; The Author(s).


Abstract

Objective

To determine the feasibility and efficacy of the laparoscopic myomectomy for large fibroids (>10 cm) with use of synchronous uterine artery embolization.

Design

A prospective observational case series of laparoscopic myomectomy performed for single and multiple uterine fibroids.

Setting

A tertiary referral center for gynecological oncology and minimal access surgery.

Population

A 15 premenopausal women with large fibroids who wished to conserve their uterus from March 2005 to August 2011.

Materials and methods

Laparoscopic myomectomy was performed using harmonic scalpel with synchronized preoperative uterine artery embolization (UAE) following multidisciplinary team discussion. Tissue retrieval was performed by morcellation.

Main outcome measures

Early discharge and reduced intraoperative blood loss.

Results

Of all 15 cases, mean number of fibroids removed was 2 (range: 1-4) and mean mass of tissue excised was 450 gm (range: 320-1540). The mean diameter of the fibroids removed was 13 cm (range: 10-20 cm). Mean estimated blood loss was 156 ml (range: 25-1,000 ml) and the mean operating time was 113 minutes (17-200 minutes). All cases were successfully completed laparoscopically with no conversions to open surgery. One patient who had a 13 cm broad ligament fibroid required a 2 unit blood transfusion intraoperatively and another patient developed a single port-site infection 2 weeks following the procedure. Histology confirmed benign leiomyomas in all cases.

Conclusion

Laparoscopic myomectomy with use of synchronized UAE using harmonic scalpel is feasible and efficient procedure for single or multiple large fibroids within an experienced multidisciplinary setting.

How to cite this article

Kamran MW, Madhuri TK, Walker WJ, Butler-Manuel SA. Laparoscopic Myomectomy for Large Fibroids with Synchronized use of Uterine Artery Embolization. World J Laparosc Surg 2013;6(2):107-110.


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  1. Evaluation of abnormal uterine bleeding: Comparison of three outpatient procedures within cohorts defined by age and menopausal status. Health Technol Assess 2001 Sep;8(34):1-139.
  2. CG44 Heavy Menstrual Bleeding 2007 Jan.
  3. Why do women choose endometrial ablation rather than hysterectomy? Fertil Steril 1998 Jun;69(6):1063-1066.
  4. Role of hysterectomy and its alternatives in benign uterine diseases. J Indian Med Assoc 2008 Apr;106(4):232-234.
  5. Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 2008 Aug;22(4):677-705.
  6. Laparoscopic myomectomy. Int J Fertil 1991 Sep-Oct;36:275-280.
  7. Contracept Fertil Sex 1993;21:920-922.
  8. Synchronous uterine artery embolization and laparoscopic myomectomy for massive uterine leiomyomas. JSLS 2010;14:120-122.
  9. Long-term follow-up of uterine artery embolisation—an effective alternative in the treatment of fibroids. BJOG 2006;113:464-468.
  10. Laparoscopy or laparotomy. Contracept Fertil Sex 1996;24(10):751-756.
  11. Italian multicenter study on complication of laparoscopic myomectomy. J Minim Invasive Gynecol 2007 Jul-Aug;14(4):453-462.
  12. The indications, surgical techniques, and limitations of laparoscopic myomectomy. JSLS 2003;7:89-95.
  13. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2011 Nov9;11:CD005355.
  14. Intramyometrial vasopressin as a haemostatic agent during myomectomy. BJOG 1994 May;101(5):435-437.
  15. Uterine perfusion following laparoscopic clipping of uterine arteries at myomectomy. Aust N Z J Obstet Gynaecol 2009 Oct;49(5):559-560.
  16. A transient blocking uterine perfusion procedure to decrease operative blood loss in laparoscopic myomectomy. Chang Gung Med J 2008 Sep-Dec;31(5):463-468.
  17. Combined treatment of uterine myoma (uterine arteries embolization followed by laparoscopic myomectomy). Ceska Gynekol 2004 Nov;69(6):497-500.
  18. Uterine artery embolization with resorbable material prior to myomectomy. J Radiol 2008 Dec;89(12):1925-1929.
  19. Preoperative uterine artery embolization (PUAE) before uterine fibroid myomectomy. Cardiovasc Intervent Radiol 2008 May-June;31(3):514-520.
  20. A multi-centre retrospective cohort study comparing the efficacy, safety and cost-effectiveness of hysterectomy and uterine artery embolisation for the treatment of symptomatic uterine fibroids. The hopeful study. Health Technol Assess 2008 Mar;12(5):1-248.
  21. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 5-year outcome from the randomized EMMY trial. Am J Obstet Gynecol 2010 Aug;203(2):105.
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