Wei Min Liu

Laparoscopic bipolar coagulation of uterine vessels: a new method for treating symptomatic fibroids.

OBJECTIVE To evaluate the effects of laparoscopic bipolar coagulation of uterine vessels in treating symptomatic fibroids. DESIGN Prospective clinical study. SETTING University-affiliated tertiary referral center. PATIENT(S) Eighty-seven women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri. INTERVENTION(S) Laparoscopic bipolar coagulation of uterine arteries and anastomotic sites of uterine arteries with ovarian arteries. MAIN OUTCOME MEASURE(S) Percentage reduction in the dominant fibroid size and clinical response evaluation. RESULT(S) Eighty-five (97.7%) of 87 patients underwent technically successful laparoscopic coagulation of uterine vessels without intraoperative complications. The mean follow-up time was 10.2 months. Symptomatic improvement was reported in 76 (89.4%) of 85 patients, including 18 (21.2%) with complete resolution of symptoms. Significant reductions in the dominant fibroid size (average, 76%) and the uterine volume (average, 46%) were sonographically demonstrated. Two patients conceived 4 and 9 months, respectively, after treatment. Three (3.5%) premenopausal women became postmenopausal postoperatively. CONCLUSION(S) Laparoscopic bipolar coagulation of uterine vessels appears to be a promising new method for treating fibroid-related menorrhagia and pelvic pain.

Laparoscopic Bipolar Coagulation of Uterine Vessels to Treat Symptomatic Leiomyomas

Laparoscopic bipolar coagulation of uterine vessels was performed in three women with symptomatic myomas who required conventional surgical treatment. Uterine size and dominant myoma size were assessed by ultrasonography before and after surgery. Both uterine arteries, as well as anastomosis zone of uterine arteries with ovarian arteries, were occluded in all three women. Surgery was uneventful, and patients were hospitalized for only 2 days. All women experienced improvement in symptoms with no complications. Postoperative ultrasound showed progressive reduction in size of the dominant myoma. A larger series and longer follow-up are required to evaluate long-term effects and to identify appropriate candidates.

Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma

OBJECTIVE To compare the efficacy of surgical-medical treatment and surgery alone in the treatment of uterine symptomatic adenomyoma. DESIGN Prospective nonrandomized study. SETTING Medical centers. PATIENT(S) One hundred sixty-five women treated with conservative adenomyomectomy. INTERVENTION(S) Surgery followed by six-course treatment (n = 114, surgical-medical group) or no treatment (n = 51, surgery-alone group) with a gonadotropin-releasing hormone (GnRH) agonist regimen. MAIN OUTCOME MEASURE(S) Symptom relief (scale: 0, no symptoms, to 5, worst symptoms) and relapse (when any one scale was > or =2 after treatment) during the 2-year follow-up period. RESULT(S) The general characteristics of the patients were similar in both groups, except for the diameter of the adenomyoma and age. Patients in both groups had statistically significant symptom relief, and all symptom scores declined from a mean of 3 or 4 to a mean of 1 or less at the end of the 2-year follow-up period. The symptom-relapse rates in the surgical-medical group were statistically significantly lower than those in the surgery alone group (n = 32, 28.1% vs. n = 25, 49.0%, respectively). CONCLUSION(S) Conservative surgery, regardless of GnRH agonist treatment, may be acceptable for management of a selected population with severe symptomatic adenomyoma. However, surgical-medical treatment provided more effective symptom control (a lower symptom relapse rate) than surgery alone during the 2-year follow-up period.

Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis

Aim:  Our aim was to assess the role of surgical intervention for symptom control and reproductive performance improvement in the management of subfertile women with symptomatic extensive uterine adenomyosis.

A prospective short-term evaluation of uterine leiomyomas treated by myomectomy through conventional laparotomy or ultraminilaparotomy

OBJECTIVE To evaluate the short-term therapeutic outcome of myomectomy through conventional laparotomy in the treatment of uncomplicated uterine myomas compared with myomectomy through ultraminilaparotomy. DESIGN Controlled, nonrandomized clinical study. SETTING University-affiliated tertiary care referral center. PATIENT(S) One hundred thirteen patients with symptomatic and uncomplicated uterine myomas warranting surgical treatment, who expressed a strong desire to retain their uterus. Seventy-two patients underwent myomectomy by laparotomy and 41 by ultraminilaparotomy. INTERVENTION(S) Myomectomy through laparotomy or ultraminilaparotomy access. MAIN OUTCOME MEASURE(S) The outcome was measured by comparing blood loss, need for blood transfusion, operative time, postoperative febrile morbidity, time of flatus passage after operation, and postoperative pain (visual analogue scale score and anesthesia use) in both groups. RESULT(S) General characteristics of the patients were similar in both groups. There were no statistical differences in mean operative time, blood loss, febrile morbidity, insurance pay, and therapeutic efficacy (symptom relief) between the two groups. However, postoperative recovery seemed to be better and more rapid in the ultraminilaparotomy group compared with that in the laparotomy group, including rapid and early bowel movement, lower scores on the visual analogue scale, and shortened postoperative hospital stay. CONCLUSION(S) This study demonstrates the superiority of ultraminilaparotomy in treating uncomplicated uterine myomas, compared with laparotomy, during this 1-year short-term follow-up.

Successful treatment of symptomatic arteriovenous malformation of the uterus using laparoscopic bipolar coagulation of uterine vessels.

OBJECTIVE To report a case of symptomatic arteriovenous malformation (AVM) of the uterus that was successfully treated with laparoscopic bipolar coagulation of uterine vessels. DESIGN Case report. SETTING University-affiliated tertiary referral center. PATIENT(S) A 66-year-old woman with symptomatic AVM of the uterus. INTERVENTION(S) Laparoscopic bipolar coagulation of uterine vessels. MAIN OUTCOME MEASURE(S) Clinical symptoms, color Doppler sonographic examination, and pelvic magnetic resonance imaging. RESULT(S) Remarkable shrinkage of the lesion size, obvious decrease in all of the impedance measurements (pulsatility, resistance, velocity indexes [systolic/diastolic]), and freedom from symptoms. CONCLUSION(S) This modality is a new alternative method for the management of patients with symptomatic AVM of the uterus who do not respond to conservative treatment.

Adenomyosis and its variance: adenomyoma and female fertility.

Extensive adenomyosis (adenomyosis) or its variance, localized adenomyosis (adenomyoma) of the uterus, is often described as scattered, widely-distributed endometrial glands or stromal tissue found throughout the myometrium layer of the uterus. By definition, adenomyosis consists of epithelial as well as stromal elements, and is situated at least 2.5 mm below the endometrialmyometrial junction. However, the diagnosis and clinical significance of uterine adenomyosis and/or adenomyoma remain somewhat enigmatic. The relationship between infertility and uterine adenomyosis and/or adenomyoma is still uncertain, but severe endometriosis impairs the chances of successful pregnancy when using artificial reproductive techniques. To date, there is no uniform agreement on the most appropriate therapeutic methods for managing women with uterine adenomyosis and/or adenomyoma who want to preserve their fertility. Fertility has been restored after successful treatment of adenomyosis using multiple modalities, including hormonal therapy and conservative surgical therapy via laparoscopy or exploratory laparotomy, uterine artery embolization, and other methods, including a potential but under-investigated procedure, magnetic resonance-guided focused ultrasound. This review will explore recent publications that have addressed the use of different approaches in the management of subfertile women with uterine adenomyosis and adenomyoma.

Symptomatic myoma treated with laparoscopic uterine vessel occlusion and subsequent immediate myomectomy: which is the optimal surgical approach?

OBJECTIVE To determine the optimal surgical approach when patients are treated with laparoscopic uterine vessel occlusion (LUVO) combined with myomectomy in the management of women with symptomatic uterine fibroids. DESIGN An observational study. SETTING Medical centers. PATIENT(S) One hundred thirty-one patients with symptomatic myomas underwent LUVO plus laparoscopic myomectomy (LM; LUVO+LM) (n = 49) or LUVO plus ultra-mini laparotomy UMLT-M (LUVO+UMLT-M) (n = 82). INTERVENTION(S) Myomectomy through laparoscopy or UMLT access. MAIN OUTCOME MEASURE(S) The outcome was measured by comparing surgical techniques, and 3-year follow-up, including symptom control and reintervention (hysterectomy or myomectomy), in both groups. RESULT(S) General characteristics of the patients were similar in both groups, except the number of myomas. Surgical techniques seemed to be easier in the LUVO+UMLT-M group than in LUVO+LM group, because of less operation time (56.1 +/- 16.9 minutes vs. 73.4 +/- 26.9 minutes; P=.009) and a higher success rate (100% vs. 91.8%; P=.018). There were no differences in the 3-year follow-up of the therapeutic outcomes of the LUVO+UMLT-M and LUVO+LM groups, with low reintervention rates (1.2% vs. 0) and good symptom control rates in both groups. CONCLUSION(S) The LUVO+LM, either through laparoscopy or UMLT, was acceptable in the management of symptomatic uterine fibroids. However, the LUVO+UMLT-M technique might be more feasible, as it required less operative time and had a higher success rate.

Comparison of ultraminilaparotomy for myomectomy through midline vertical incision or modified Pfannenstiel incision—a prospective short-term follow-up

OBJECTIVE To evaluate the short-term therapeutic outcome of myomectomy using ultraminilaparotomy (UMLT) through a midline vertical incision (MVI) or a modified Pfannenstiel incision (MPI) in the treatment of myomas. DESIGN Controlled, nonrandomized clinical study. SETTING University-affiliated medical center. PATIENT(S) Ninety-eight patients with symptomatic, uncomplicated myomas warranting myomectomy. Forty-three patients underwent UMLT myomectomy by MVI and 55 by MPI. INTERVENTION(S) UMLT myomectomy through MI or MPI access. MAIN OUTCOME MEASURE(S) The outcome was measured by comparing incision length, blood loss, operative time, postoperative pain, complications, success rate, postoperative recovery, and the return to work capability in both groups. RESULT(S) General characteristics of the patients were similar in both groups. There were no statistical differences in postoperative recovery, complications, and success rate between the two groups. However, the operative technique seemed to be easier and more acceptable in the MVI group compared with that in the MPI group, because of the smaller incision wound, less operation time, and less blood loss. By contrast, less postoperative pain and an earlier return to work capability were noted in the MPI group. CONCLUSION(S) This study has demonstrated that UMLT myomectomy using either a MVI or MPI can be applied in the successful management of uncomplicated myomas. The MPI technique was more complicated, but yielded less wound pain and earlier postoperative recovery for the women during this 1-year short-term follow-up.

Use of uterine vessel occlusion in the management of uterine myomas: two different approaches

OBJECTIVE To evaluate the difference between uterine artery occlusion alone (UAO) and combined (UVO) with simultaneous blockage of anastomosis between the uterine and ovarian vessels in the management of women with myomas in a 3-year follow-up. DESIGN Case-control study. SETTING University-associated hospital. PATIENT(S) One hundred ten patients with uterine fibroids. INTERVENTION(S) Forty-four patients underwent UAO and 66 patients UVO; patients were matched using a statistically generated selection of all UVOs performed during the same period. MAIN OUTCOME MEASURE(S) Outcomes were assessed by comparing surgical parameters, immediate postoperative recovery, and therapeutic outcomes. RESULT(S) During the 3-year follow-up, the majority of patients in both groups reported symptom relief (ranging from 61.5% to 84.6% in the UVO group and 31.6% to 77.3% in the UAO group, on the basis of different kinds of symptoms). However, symptom control seemed to be different between the two groups when the follow-up time was prolonged; for example, symptom control was better in the UVO group at the end of 3 years, especially for menorrhagia (76.5% vs. 34.5%). The fibroid size was smaller in the UVO group, resulting in a lower reintervention rate, compared with the UAO group (13.6% vs. 36.4%). CONCLUSION(S) If UVO is used for uterine fibroids, the 3-year efficacy might be better than that with UAO. This finding is worthy of further investigation.