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Cervical Fibroids
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Enucleation of myoma can be carried out by using a myoma screw or tenaculum where the myoma easily walks out of its bed (Figure 11.4). After complete enucleation, cervical myoma can be removed by morcellation. If complete enucleation is difficult because of large size and deep location or limited pelvic space for traction, the myoma can be morcellated when it is still attached to the uterus [22]. The approach depends on the size and location of the myoma and the expertise or varied practices of different surgeons. Usually, in situ morcellation can cause excessive blood loss; hence, the operator needs good teamwork for faster and safer morcellation.
Hysteroscopic Myomectomy
Published in John C. Petrozza, Uterine Fibroids, 2020
Karissa Hammer, John C. Petrozza
Prior to recommending a hysteroscopic myomectomy, a patient must have a thorough evaluation. A detailed history and physical is required, with specific concern for symptoms related to the fibroid such as excessive vaginal bleeding, anemia, pain, miscarriages or other fertility concerns. Understanding of the patient's other comorbidities and surgical history is also pertinent to assess readiness to undergo surgery with either local or general anesthesia. Patients must be medically optimized prior to the procedure. Physical exam should include an assessment of the uterine position and size, as well as the size and location of fibroid(s), if palpable. A pelvic ultrasound, at minimum, should be obtained to capture the location of the fibroid(s) and assess accessibility from the intracavitary approach [2]. If this image modality is not successful in delineating myoma location, a saline sonography and/or MRI can be performed [3]. Figure 20.1 illustrates a FIGO 0 fibroid and endometrial polyp within the uterine cavity by sonohysterogram.
Fibroids and Assisted Reproduction Technology
Published in Botros R.M.B. Rizk, Yakoub Khalaf, Mostafa A. Borahay, Fibroids and Reproduction, 2020
This is a noninvasive modality to treat uterine myoma. The high-intensity, focused ultrasound energy is directed to the fibroid with subsequent coagulation tissue necrosis of the fibroid without damaging nearby tissues. This treatment is guided with the use of magnetic resonance (high-frequency magnetic resonance–guided focused ultrasound surgery [MRgFUS]) or ultrasound (ultrasound-guided high-intensity focused ultrasound [USgHIFU]).
Serum sestrin 2 levels in patients with uterine leiomyomas
Published in Journal of Obstetrics and Gynaecology, 2022
Meric Kabakci, Nura Fitnat Topbas Selcuki, Zelal Aydin, Kubra Bagci, Cihan Kaya, Pinar Yalcin Bahat
The mean age was 38.7 ± 4.3 years for the myoma group and 36.3 ± 5.4 years for the control group, with no statistically significant difference between them (p = 0.06). Likewise, there was no significant difference between the BMI values of two groups, which were 27 (21–39) and 28 (18–38) for the myoma and control groups, respectively (p = 0.84). The mean gravida was 3 (0–6) for the myoma group and 3 (0–7) for the control group, again with no statistically significant difference (p = 0.21). There was also no significant difference in mean parity, which was 2 (0–6) for the myoma group and 3 (0–6) for the control group (p = 0.11). When gynecological symptoms were analysed, pelvic pain was reported in 20 (64.5%) patients in the myoma group and 18 (60%) patients in the control group, with no significant difference (p = 0.71). Dyspareunia was observed in 12 (38.7%) and 11 (36.7%) women in the myoma and control groups, respectively, with no significant difference (p = 0.86). Meanwhile, menorrhagia differed statistically significantly between groups, affecting 23 (74.2%) patients in the myoma group and 14 (46.7%) patients in the control group (p = 0.02). There was also a significant difference between the groups in terms of family history of myoma. Eighteen (58.1%) patients confirmed a family history in the myoma group, whereas none reported a positive family history in the control group (30, 100%) (p < 0.001). The mean calculated myoma volume for the study group was 180 cm3 (30–1440).
Preliminary study on ultrasound-guided high-intensity focused ultrasound ablation for treatment of broad ligament uterine fibroids
Published in International Journal of Hyperthermia, 2021
Yiran Wang, Yonghua Xu, Felix Wong, Yi Wang, Yu Cheng, Lixia Yang
Two hundred and thirty-six patients with symptomatic uterine fibroids were enrolled and treated with ultrasound-guided HIFU under conscious sedation between January 2017 and December 2018. All patients signed the written informed consent before treatment. The inclusion and exclusion criteria were reported in one of our previous studies [5]. MRI scans confirmed the presence of 13 broad ligament uterine fibroids in 12 patients, and their data were collected retrospectively and analyzed. The patients’ mean age was 38.6 years ± 6.3 years (range 24 − 46 years). These patients had mild to moderate pelvic compression symptoms, including frequent urination, low back pain, and constipation. Among them, there were no other symptoms in five patients, and the remaining seven patients simultaneously with submucosal or intramural myoma and BLUF had menorrhagia, dysmenorrhea, anemia or lower abdominal pain. All patients had contrast-enhanced MRI before, immediately post-operation, and at six months after the procedure. The non-perfusion volume ratio (NPV ratio), reduction of fibroid volumes, symptom changes, adverse events, and complications associated with the HIFU ablation were analyzed.
A novel approach to infertility treatment of advance-age patient with prominent intramural fibroid
Published in Gynecological Endocrinology, 2018
Raoul Orvieto, Eran Zilberberg, Valeria Stella Vanni, Amnom Botchan
Uterine fibroids are the most common benign tumor of the female genital tract, with an estimated prevalence of 20–50% of the reproductive age women [1]. A recent ASRM practice committee guideline has demonstrated that there is insufficient evidence to conclude that myomas reduce the likelihood of achieving pregnancy with or without fertility treatment, nor any evidences that a specific myoma size, number, or location (excluding submucosal myomas or intramural myomas impacting the endometrial cavity contour) is associated with a reduced likelihood to conceive and deliver [2]. Nevertheless, the overall evidence supports the concept that submucosal and intramural fibroids causing intracavity distortion should be treated with myomectomy, whereas subserosal fibroids should be managed expectantly [2–5].