Tóm tắt
Aim: To describe characteristics of uterine fibroids and evaluate the effectiveness of laparoscopic myomectomy.
Methods: Cross-sectional observative study in fifty-two patients underwent laparoscopic myomectomy at Department of Obstetrics and Gynecology, Hospital of Hue Medicine and Pharmacy University and Hue Central Hospital from 6/2019 to 6/2021. Inclusion criteria were patients with ≤ 5 fibroids, largest diameter did not exceed 10cm in diameter and no contraindication for laparoscopy. Patients were operated laparoscopically and manually morcellated by vaginal route, without electrical morcellator.
Results: Mean age was 42.3 ± 4.2 years old. The most common symptom was abnormal uterine bleeding (42.3%). The mean diameter was 66.8 ± 16.3 mm. The success rate of laparoscopic myomectomy was 98.1%. The mean operation time was 148.66 ± 51.4 min. Diameter ≥ 80mm, multiple fibroids (>5 fibroids) and operation time ≥ 180 min (p < 0.05) were associated factors of significant Hemoglobin drop and prolonged surgery.
Conclusions: Laparoscopic myomectomy had high success rate and low complication rate, however appropriate indication and experienced surgeon were necessary.
Tài liệu tham khảo
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8. Jin C, Hu Y, Chen XC, al. e. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):14-21.
9. Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, et al. Vaginal birth after prior myomectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018;231(4):198-203.
10. Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? Journal of minimally invasive gynecology. 2008;15(3):292-300.
11. United States Food and Drug Administration. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy 2014 [16 July 2021]. Available from: https://www.fda.gov/media/88703/download.
12. Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal manual morcellation of very large uteri within an enclosed endoscopic bag: Our 5-year experience. J Minimal Invasive Gynecol. 2016;23(6):903-8.
13. Sleiman Z, Baba RE, Garzon S, Khazaka A. The Significant Risk Factors of Intra-Operative Hemorrhage during Laparoscopic Myomectomy: A Systematic Review. Gynecology and minimally invasive therapy. 2020;9(1):6-12.
14. Ye M, Zhou J, Chen J, Yan L, Zhu X. Analysis of hidden blood loss and its influential factors in myomectomy. The Journal of international medical research. 2020;48(5):1-11.
15. 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(8):1726-31.
16. Movilla P, Orlando M, Wang J, Opoku-Anane J. Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time. Journal of minimally invasive gynecology. 2020;27(3):646-54.
17. Watrowski R, Jäger C, Forster J. Predictors of postoperative hemoglobin drop after laparoscopic myomectomy. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. 2017;12(1):81-7.
18. Bean EM, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients. Journal of minimally invasive gynecology. 2017;24(3):485-93.
19. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, et al. Italian multicenter study on complications of laparoscopic myomectomy. Journal of minimally invasive gynecology. 2007;14(4):453-62.
20. Abouzid A, Shetiwy M, Hassan A, Elghaffar MA. Scalpel Morcellation During Laparoscopic Hysterectomy for Large Uterine Fibroids. Is It a Safe Alternative to Power-Morcellation?
21. Clark Donat L, Clark M, Tower AM, Menderes G, Parkash V, Silasi DA, et al. Transvaginal morcellation. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2015;19(2).
22. Meurs E, Brito LG, Ajao MO, Goggins ER, Vitonis AF, Einarsson JI, et al. Comparison of Morcellation Techniques at the Time of Laparoscopic Hysterectomy and Myomectomy. Journal of minimally invasive gynecology. 2017;24(5):843-9.
23. Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. American journal of obstetrics and gynecology. 2012;207(2):112.e1-6.
2. Jenabi E, Fereidooni B. The uterine leiomyoma and placenta previa: a meta-analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2019;32(7):1200-4.
3. Jenabi E, Khazaei S. The effect of uterine leiomyoma on the risk of malpresentation and cesarean: a meta-analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2018;31(1):87-92.
4. Jenabi E, Ebrahimzadeh Zagami S. The association between uterine leiomyoma and placenta abruption: A meta-analysis. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2017;30(22):2742-6.
5. Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids. Best practice & research Clinical obstetrics & gynaecology. 2016;34:66-73.
6. Mallick R, Odejinmi F. Pushing the boundaries of laparoscopic myomectomy: a comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre. Gynecological Surgery. 2017;14(1):22.
7. D'Silva EC, Muda AM, Safiee AI, Ghazali W. Five-Year Lapsed: Review of Laparoscopic Myomectomy versus Open Myomectomy in Putrajaya Hospital. Gynecology and minimally invasive therapy. 2018;7(4):161-6.
8. Jin C, Hu Y, Chen XC, al. e. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145(1):14-21.
9. Gambacorti-Passerini ZM, Penati C, Carli A, Accordino F, Ferrari L, Berghella V, et al. Vaginal birth after prior myomectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2018;231(4):198-203.
10. Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? Journal of minimally invasive gynecology. 2008;15(3):292-300.
11. United States Food and Drug Administration. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy 2014 [16 July 2021]. Available from: https://www.fda.gov/media/88703/download.
12. Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal manual morcellation of very large uteri within an enclosed endoscopic bag: Our 5-year experience. J Minimal Invasive Gynecol. 2016;23(6):903-8.
13. Sleiman Z, Baba RE, Garzon S, Khazaka A. The Significant Risk Factors of Intra-Operative Hemorrhage during Laparoscopic Myomectomy: A Systematic Review. Gynecology and minimally invasive therapy. 2020;9(1):6-12.
14. Ye M, Zhou J, Chen J, Yan L, Zhu X. Analysis of hidden blood loss and its influential factors in myomectomy. The Journal of international medical research. 2020;48(5):1-11.
15. 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(8):1726-31.
16. Movilla P, Orlando M, Wang J, Opoku-Anane J. Predictors of Prolonged Operative Time for Robotic-Assisted Laparoscopic Myomectomy: Development of a Preoperative Calculator for Total Operative Time. Journal of minimally invasive gynecology. 2020;27(3):646-54.
17. Watrowski R, Jäger C, Forster J. Predictors of postoperative hemoglobin drop after laparoscopic myomectomy. Wideochirurgia i inne techniki maloinwazyjne = Videosurgery and other miniinvasive techniques. 2017;12(1):81-7.
18. Bean EM, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients. Journal of minimally invasive gynecology. 2017;24(3):485-93.
19. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, et al. Italian multicenter study on complications of laparoscopic myomectomy. Journal of minimally invasive gynecology. 2007;14(4):453-62.
20. Abouzid A, Shetiwy M, Hassan A, Elghaffar MA. Scalpel Morcellation During Laparoscopic Hysterectomy for Large Uterine Fibroids. Is It a Safe Alternative to Power-Morcellation?
21. Clark Donat L, Clark M, Tower AM, Menderes G, Parkash V, Silasi DA, et al. Transvaginal morcellation. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2015;19(2).
22. Meurs E, Brito LG, Ajao MO, Goggins ER, Vitonis AF, Einarsson JI, et al. Comparison of Morcellation Techniques at the Time of Laparoscopic Hysterectomy and Myomectomy. Journal of minimally invasive gynecology. 2017;24(5):843-9.
23. Ghezzi F, Cromi A, Uccella S, Bogani G, Serati M, Bolis P. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. American journal of obstetrics and gynecology. 2012;207(2):112.e1-6.
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