Organ-preserving laparoscopic myomectomy in atypical leiomyoma arrangement

Abstract

BACKGROUND: Uterine fibroids are the most common cause of surgical treatment in women and total hysterectomy is performed in most cases to radically solve this problem. The organ-preserving approach aims to preserve fertility and the ability to reproduce in patients of reproductive age. The atypical location of leiomyomas complicates the possibility of performing an organ-preserving myomectomy.

AIM: The aim of this study was to assess the possibility of performing myomectomy for atypical leiomyoma using laparoscopic access in routine practice to preserve fertility and implement reproductive plans.

MATERIALS AND METHODS: This study included 213 patients of reproductive age with uterine fibroids. Myomectomy for typical or atypical leiomyomas was performed by laparoscopic access. A comparative analysis of surgical treatment and perioperative management of patients with atypically located fibroids and fibroids of other localization was carried out. The results of the achievement by the patients of their reproductive goals were evaluated. The duration of follow-up was 24 months.

RESULTS: Atypical node location was noted in 65 (30.5%) cases. When comparing the duration of surgical treatment, volume of blood loss, need for analgesics, presence of intraoperative and postoperative complications, duration of hospitalization and recovery period in patients with atypical leiomyoma, these parameters did not differ from those in the surgical treatment of patients with typical leiomyoma. Anatomical and functional results of surgical treatment were analyzed after one, three, six, 12, and 24 months. Of the 70 patients planning pregnancy, 26 (37%) women became pregnant on average 8.3 months after surgery. The location of the removed fibroids was atypical in ten cases.

CONCLUSIONS: The atypical location of leiomyoma does not affect the course of the surgical and postoperative periods and long-term results of surgical treatment. The possibility of routine organ-preserving treatment by laparoscopic access in patients with atypical fibroids leaves prospects for the implementation of the woman’s reproductive plans.

Keywords

uterine fibroids / laparoscopy / myomectomy / atypical leiomyoma

References

[1] Arutyunova EE, Katkova AS, Buralkina NA. Ethnogeography of uterine fibroids: epidemiology, age and race differences, types of surgery. Consilium Medicum. 2018;20(6):26–30. EDN: UZEXJI doi: 10.26442/2075-1753_2018.6.26-30

[2] Арутюнова Е.А., Каткова А.С., Буралкина Н.А. Этногеография миомы матки: эпидемиология, возрастные и расовые различия, виды оперативных вмешательств // Consilium Medicum. 2018. Т. 20, № 6. С. 26–30. EDN: UZEXJI doi: 10.26442/2075-1753_2018.6.26-30

[3] Stewart EA, Cookson CL, Gandolfo RA, et al. Epidemiology of uterine fibroids: a systematic review. BJOG. 2017;124(10):1501–1512. doi: 10.1111/1471-0528.14640

[4] Stewart E.A., Cookson C.L., Gandolfo R.A., et al. Epidemiology of uterine fibroids: a systematic review // BJOG. 2017. Vol. 124, N 10. P. 1501–1512. doi: 10.1111/1471-0528.14640

[5] Seregin AA, Nadezhdenskaia AB, Makarova AS, et al. Uterine fibroids, laparoscopic surgery and morcellation: comparative analysis of the results of organ-preserving operations. Gynecology. 2021;23(1):73–77. EDN: JQBEKV doi: 10.26442/20795696.2021.1.200561

[6] Серегин А.А., Надежденская А.Б., Макарова А.С., и др. Миома матки, лапароскопическая хирургия и морцелляция: сравнительный анализ результатов органосохраняющих операций // Гинекология. 2021. Т. 23, № 1. С. 73–77. EDN: JQBEKV doi: 10.26442/20795696.2021.1.200561

[7] Tskhay VB, Schtoh EA. Uterine fibroids and women’s reproductive funcction. Communication uterine fibroids with infertility. Obstetrics, Gynecology and Reproduction. 2014;6(4):42–47. EDN: TMKODL

[8] Цхай В.Б., Штох Е.А. Миома матки и репродуктивная функция женщины. Связь миомы матки с бесплодием // Акушерство, гинекология и репродукция. 2014. Т. 6, № 4. С. 42–47. EDN: TMKODL

[9] Averiaskina MN, Bakhtiyarov KR. The effect of various surgical techniques in myomectomy on reproductive outcomes (a review). Russian Journal of Human Reproduction. 2024;30(1):109–115. EDN: OSLGPF doi: 10.17116/repro202430011109

[10] Аверяскина М.Н., Бахтияров К.Р. Влияние различных хирургических техник при миомэктомии на репродуктивные исходы (обзор литературы) // Проблемы репродукции. 2024. Т. 30, № 1. С. 109–115. EDN: OSLGPF doi: 10.17116/repro202430011109

[11] Saveleva GM, Sukhikh GT, Serov VN, et al, editors. Gynecology. National guide. Short edition. Moscow: GEOTAR-Media; 2020. 1044 p. (In Russ.)

[12] Савельева Г.М., Сухих Г.Т., Манухина И.Б. Гинекология: национальное руководство. Москва: ГЭОТАР-Медиа, 2015. 690 с.

[13] Carranco RC, Vigeras A, Ribeiro R, et al. Laparoscopic variants of temporary uterine artery ligation. J Minim Invasive Gynecol. 2020;27(4):811–812. doi: 10.1016/j.jmig.2019.08.026

[14] Carranco R.C., Vigeras A., Ribeiro R., et al. Laparoscopic variants of temporary uterine artery ligation // J Minim Invasive Gynecol. 2020. Vol. 27, N 4. P. 811–812. doi: 10.1016/j.jmig.2019.08.026

[15] Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. 2016;22(6):665–686. doi: 10.1093/humupd/dmw023

[16] Donnez J., Dolmans M.M. Uterine fibroid management: from the present to the future // Hum Reprod Update. 2016. Vol. 22, N 6. P. 665–686. doi: 10.1093/humupd/dmw023

[17] Metwally M, Raybould G, Cheong YC, et al. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2020;1(1). doi: 10.1002/14651858.CD003857.pub4

[18] Metwally M., Raybould G., Cheong Y.C., et al. Surgical treatment of fibroids for subfertility // Cochrane Database Syst Rev. 2020. Vol. 1, N 1. doi: 10.1002/14651858.CD003857.pub4

[19] Ordás P, Spagnolo E, Fernández LG, et al. Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: a single-center cohort study. Front Surg. 2022;9. doi: 10.3389/fsurg.2022.997078

[20] Ordás P., Spagnolo E., Fernández L.G., et al. Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: a single-center cohort study // Front Surg. 2022. Vol. 9. doi: 10.3389/fsurg.2022.997078

[21] Mokhov EM, Kadykov VA, Sergeev AN, et al. Pain scoring systems and their application features in medicine (literature review). Upper Volga Medical Journal. 2019;18 (2):34–37. EDN: DEYKPY

[22] Мохов Е.М., Кадыков В.А., Сергеев А.Н. и др. Оценочные шкалы боли и особенности их применения в медицине (обзор литературы) // Верхневолжский медицинский журнал. 2019. Т. 18, № 2. С. 34–37. EDN: DEYKPY

[23] Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(Suppl 11):S240–S252. doi: 10.1002/acr.20543

[24] Hawker G.A., Mian S., Kendzerska T., et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) // Arthritis Care Res (Hoboken). 2011. Vol. 63, Suppl. 11. P. S240–S252. doi: 10.1002/acr.20543

RIGHTS & PERMISSIONS

Eсо-Vector