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Robot-Assisted Myomectomy
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Arnold P. Advincula, Chetna Arora
Uterine leiomyomas are very common, occurring in up to 80% of reproductive-age women [1]. Over 50% of women with uterine leiomyomas are symptomatic, and the majority present with abnormal uterine bleeding, bulk symptoms from mass effect on surrounding structures, pelvic pain, recurrent pregnancy loss, and even infertility [2–4]. As a result, they are the single most common indication for hysterectomy and the source of a significant public health burden [2, 4].
Role of Aromatase Inhibitors (AIs) and Selective Estrogen Receptor Modulators (SERMs) in the Treatment of Uterine Leiomyoma
Published in John C. Petrozza, Uterine Fibroids, 2020
There are only a few medical treatments for uterine leiomyoma that are proved to be effective. The data supporting the use of aromatase inhibitors (AIs) are scant; however, some of the results are promising. Aromatase inhibition can be accomplished by two subclasses of compounds: the ones that form an irreversible bound to aromatase (exemestane) and the ones that have reversible competition such as letrozole and anastrazole [11]. There are three generations of aromatase inhibitors (Table 13.1). Anastrazole and letrozole are the most commonly used in clinical practice, resulting in 98%–99% suppression of aromatase activity [11].
Cervical and uterine cancers
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Rosemarie Forstner, Andrea Rockall
The issue of leiomyosarcoma misdiagnosed as leiomyoma has emerged in the background of minimally invasive treatment of uterine leiomyomas. It has been shown that uterine morcellation carries a risk of disseminating unexpected malignancy (235). Unexpected leiomyoma variants or sarcoma were reported in 1.2% of presumed simple leiomyomas treated by power morcellation (236). MRI is helpful in triaging patients with atypical features of leiomyomas that are associated with a higher risk of malignancy at morcellation (235).
Single-Incision Plus One Port Laparoscopic Surgery for Myomectomy: A Retrospective Study
Published in Journal of Investigative Surgery, 2023
Gaoli Niu, Hua Zhao, Hong Wang, Lingli Zhao, Yanhong Zhai
Uterine leiomyomas, also called uterine fibroids or myomas, are the most common benign gynecological tumors of women of reproductive age [1]. Although many patients remain asymptomatic, 30–40% develop various symptoms, including irregular vaginal bleeding, pelvic pain, infertility, and pelvic mass, solely due to the size and location of the uterine myomas [2]. Moreover, long-term irregular vaginal bleeding may occur in some patients, which may lead to severe anemia [3,4]. An estimated 26% of patients with uterine leiomyomas become symptomatic and require medical intervention. Although hysterectomy is the most common surgical option in such cases, myomectomy is adopted for women who require uterine-sparing during treatment [5]. This study was undertaken to evaluate the gynecologic endoscopic surgical techniques, including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy, used in the treatment of uterine myomas, with the aim to improve pregnancy outcomes and fewer postoperative complications.
Intrauterine Fetal Demise Associated with Vascular Malperfusion and Multiple Uterine Leiomyomata: A Report of Two Cases
Published in Fetal and Pediatric Pathology, 2023
Tess E. K. Cersonsky, Megan Lord, Halit Pinar
Management of leiomyomata in those desiring future fertility is complex; the preferred approach to resection is myomectomy, though recurrence is always possible [17]. This approach often requires that patients delay conception until after surgery and carries the risk of hysterectomy at the time of myomectomy [37,38]. There are no published guidelines for management of leiomyomata post-stillbirth. In our first case, the patient underwent myomectomy and, at the time of this case report, is in the third trimester of pregnancy. It is also unclear as to how the vascularity of the uterine cavity may be affected for future pregnancies given the abnormalities of uterine arteries in those with multiple leiomyomata [30]. Leiomyomata have been observed to disrupt the normal architecture and flow within the uterine arteries; such alterations have been associated with adverse pregnancy outcomes such as PEC and small size for gestational age, as well as sub-fertility [30,39–41]. Further histopathologic analysis or real-time Doppler evaluation of these uteri may yield information regarding the long-term effect of leiomyomata on placental vascular integrity.
Simvastatin-loaded liposome nanoparticles treatment for uterine leiomyoma in a patient-derived xenograft mouse model: a pilot study
Published in Journal of Obstetrics and Gynaecology, 2022
Malak El Sabeh, Kathleen L. Vincent, Sadia Afrin, Massoud Motamedi, Jamal Saada, Jinping Yang, Bulent Ozpolat, Gokhan S. Kilic, Mostafa A. Borahay
Simvastatin is a hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor that is commonly used for the treatment of hypercholesteremia. This drug has pleiotropic effects including several anti-tumour effects (Zeybek et al. 2018). In uterine leiomyoma, simvastatin was shown to induce calcium-dependent apoptosis, decrease proliferation and reduce extracellular matrix deposition, a key feature in uterine leiomyoma development (Afrin et al. 2020; Borahay et al. 2014; Malik et al. 2018). In addition, it was shown to decrease the incidence of leiomyoma in an epidemiologic study (Borahay et al. 2016). Simvastatin is a prodrug that is activated by first-pass hepatic metabolism and has a half-life of 1–2 h (Garcia et al. 2003). The bioavailability of statins is considered poor due to low aqueous solubility and low permeability in the tissues (Petyaev 2015).