Abstract Introduction Operative morbidity of laparoscopic myomectomy largely relates to the potential for intraoperative blood loss. We sought to determine whether blood loss varies according to the menstrual cycle. Material and methods A retrospective study of 268 women who underwent a laparoscopic myomectomy from 2007 to 2012. Patients were categorized into five menstrual groups: follicular phase, luteal phase, oligomenorrheic or amenorrheic on hormonal therapy, postmenopausal or other. Patient and procedure characteristics were compared for the follicular phase group, luteal phase group, and hormonal therapy group. The estimated blood loss was compared across the five groups using a regression model. Results A total of 268 women underwent a laparoscopic myomectomy: 108 (40.3%) were in the follicular phase, 92 (34.3%) were in the luteal phase, 44 (16.4%) were on hormonal therapy, nine (3.4%) were postmenopausal, and 15 (5.6%) could not be classified. Baseline patient characteristics were similar between the groups with the exception of endometriosis. Geometric mean estimated blood loss was 91.9 mL in the follicular phase group, 108.7 mL in the luteal phase group, 114.1 mL in the hormonal therapy group, and 39.8 mL in the postmenopausal group. There was no significant difference in the geometric mean estimated blood loss when comparing the follilcuar phase, luteal phase, and hormonal phase groups ( p = 0.41). Upon adjusted multivariable analysis of all five menstrual groups, there was also no difference in estimated blood loss. Conclusions Intraoperative blood loss during laparoscopic myomectomy does not vary significantly with the phase of the menstrual cycle.
Since the 2014 Food and Drug Administration communication regarding the use of power morcellation, gynecologists have adopted alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by gynecologic surgeons for tissue extraction following minimally invasive hysterectomy or myomectomy for fibroids.An online survey was distributed to all AAGL members and responses were collected between March 26, 2019 and April 17, 2019.Four hundred thirty-six respondents completed the survey. For hysterectomy, the most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) or minilaparotomy (66.9%). Nearly one-third (31.7%) endorsed using power morcellation. For myomectomy, manual morcellation via minilaparotomy (71.9%) was the most common approach, followed by power morcellation (35.7%). Use of containment bags was common. Minilaparotomy incisions were typically three cm and most often at the umbilicus.Geographic differences were detected, particularly with power morcellation. During hysterectomy, 18.4% of US-based surgeons reported its use, compared to 56.9% of nonUS-based surgeons. During myomectomy, 20.5% of US-based surgeons reported its use compared to 67.5% of their international counterparts. Age, years in practice, fellowship training, and practice location were all significantly associated with power morcellator use.A large majority of practitioners are performing manual morcellation through the colpotomy or minilaparotomy. Use of containment bags is common with all routes of tissue removal. Power morcellation use is less common in the United States than in other countries.
Introduction: Parasitic leiomyoma is a rare condition that may be spontaneous or iatrogenic in origin.Laparoscopic uterine surgery and tissue morcellation are procedures that may lead to the development of parasitic leiomyoma.Case Description: We report the case of a 36-year-old woman with a history of a laparoscopic myomectomy and uncontained power morcellation who presented to our institution 6 years later with 2 large parasitic fibroids together weighing over 1 kg.We additionally present a review of the literature on development of parasitic leiomyoma after myomectomy, summarizing 35 published cases in addition to our own. Conclusion:Parasitic leiomyoma is estimated to occur after 0.20 to 1.25% of laparoscopic myomectomies, and is diverse in it's presenting symptoms and surgical findings.Tissue morcellation is suspected to be a risk factor in the development of this condition.
Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Matthew T. SiedhoffMatthew T. SiedhoffMatthew T. Siedhoff completed his medical degree at Stanford University, USA and obstetrics and gynecology residency training at New York University, USA. He then went on to complete an AAGL fellowship in Minimally Invasive Gynecologic Surgery (MIGS) at the University of North Carolina at Chapel Hill (UNC), USA, and received a master's degree in clinical research from UNC's Gillings School of Public Health during fellowship. As faculty at UNC, he served as MIGS fellowship and division director. He joined Cedars-Sinai in Los Angeles, USA, at the end of 2015. The MIGS practice has rapidly grown to include three providers, and Dr Siedhoff now serves as the Vice Chair for Gynecology for the department. He performs advanced laparoscopic surgery for a range of gynecologic conditions, with special interest and expertise in large fibroids and complicated endometriosis. His research interests focus on surgical outcomes and he has published important trials on topics such as bowel preparation and opportunistic salpingectomy, as well as decision analysis research on uterine tissue extraction. He is very involved with AAGL Elevating Gynecologic Surgery, serving as course faculty in the United States and internationally. He has served as President for its fellowship board and on the editorial board for its journal, the Journal of Minimally Invasive Gynecologic Surgery, as well as its video platform, SurgeryU. He is currently a site reviewer for the fellowship. He has helped organize and lead local simulation sessions on suturing, hysteroscopy, laparoscopy, and tissue extraction at Cedars-Sinai and similar work in national and international courses. He has served as the course chair for the past five years of the fellowship in MIGS boot camp, which includes cadaveric instruction, low- and high-fidelity simulation, and simulated skills training such as managing hemorrhage and providing patients with difficult news. Nisse V. ClarkNisse V. ClarkNisse V. Clark is a board-certified obstetrician and gynecologist. She completed her medical school at Loyola University in Chicago, Illinois, USA, and her residency training at Tufts University in Boston, Massachusetts, USA. Afterwards, she completed a fellowship in Minimally Invasive Gynecologic Surgery (MIGS) at Brigham and Women's Hospital in Boston, Massachusetts, USA. During fellowship, she completed a Master of Public Health at Harvard T.H. Chan School of Public Health, USA. Currently, she directs MIGS at Massachusetts General Hospital and is a faculty member at Harvard Medical School in Boston, Massachusetts, USA. She devotes most of her time to caring for women with complex gynecologic conditions, with a focus on laparoscopic procedures for fibroids and endometriosis. She is an avid clinical researcher with multiple publications evaluating outcomes of gynecologic surgery. She is also an active member of the American Association of Gynecologic Laparoscopists (AAGL) as both a committee chair and member. Ruben AlveroRuben AlveroDr Ruben Alvero is Professor of Obstetrics and Gynecology at Stanford University School of Medicine, USA and the Division Director of Reproductive Endocrinology and Infertility at the Lucille Packard Children's Hospital in Palo Alto, California, USA. He graduated from Harvard College and received his medical degree from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA. He completed his residency at the Walter Reed Army Medical Center and his fellowship in Reproductive Endocrinology and Infertility (REI) at the National Institutes of Health. Previously, Dr Alvero was Professor and Division Director at the University of Colorado, USA and Brown University, USA, Fellowship Director in REI at Brown, and Residency Program Director of Obstetrics and Gynecology at the University of Colorado. A 27-year veteran of the United States Army, he retired as a Colonel. A native Spanish speaker, Dr Alvero is devoted to the care of underserved populations.
With the impending withdrawal of Essure from the US market, ob/gyns should know how to remove the device. The authors describe the traditional technique and their new approach.
