Diagnosis of a mullerian anomaly by vaginoscopic approach (original) (raw)
Related papers
Successful Reproductive Outcome Following Challenging Surgical Management of Mullerian Anomalies
Scholars Journal of Applied Medical Sciences
Background: Mullerian duct anomalies consist of a set of structural malforma-tions of reproductive organ resulting from abnormal development of the paramesonephric or Müllerian ducts. The prevalence of these anomalies ranges from 0.001 to 10% in the general population and from 8-10% in women with an adverse reproductive history. The aim of this study was to diagnose different type of mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of surgical management of malformation of genital tract. Methods: A prospective observational study of mullarian anomalies and its diagnosis & reproductive outcome was observed by using data from women with congenital anomalies attended in OPD either with complains or incidental diagnosis with HSG,during laparoscopy at tertiary care center. Total 100 women with different types of mullarian anomalies were included in study. Results: Most common utero-vaginal anomaly seen in present study was septate uterus with on basis ...
Laparoscopic myomectomy and pregnancy outcome in infertile patients
Fertility and Sterility, 1999
Objective: To assess outcomes and pregnancy-related complications after laparoscopic myomectomy in infertile patients. Design: Retrospective analysis. Setting: Tertiary care advanced laparoscopic center. Patient(s): Twenty-eight infertile patients with at least one uterine leiomyoma of Ͼ5 cm in diameter. Intervention(s): Laparoscopic myomectomy. Main Outcome Measure(s): Occurrence of pregnancy, delivery rate, and pregnancy-related complications. Result(s): The average size of the myomas removed was 6 cm (range, 4 -13.3 cm). None of the procedures were converted to laparotomy. The postoperative rate of intrauterine pregnancy was 64.3% (n ϭ 18), including 1 of 2 patients who underwent concomitant hysteroscopic myomectomy. Four patients had spontaneous abortions and 14 delivered viable term neonates. Six women had a vaginal delivery without complications and 8 had a cesarean section. No antepartum or intrapartum complications were reported. Conclusion(s): Laparoscopic myomectomy can be offered to patients who want to have children and who refuse to undergo an abdominal myomectomy. Patient selection as well as meticulous surgical technique are the key factors in achieving a successful outcome. (Fertil Steril 1999;71:571-4.
Acta Medica Transilvanica
Pelvic masses are commonly diagnosed following clinical examination. These may be located in the genital organs or may interest other pelvic and abdominal organs. The pathology of the pelvic masses varies with age. The postmenopausal period is most commonly associated with malignant pathology while reproductive age is associated with benign pathology. The purpose of this paper is to present the experience of the Obstetrics and Gynaecology Clinic of the Sibiu County Clinical Emergency Hospital in laparoscopic myomectomy. We evaluated the patients admitted to the Obstetrics and Gynaecology Clinic of the Emergency County Clinical Hospital in Sibiu who underwent a laparoscopic myomectomy between 1.01.2015 - 06.06.2019. During this time, 14 laparoscopic myomectomies were performed in our clinic. Patients ranged in age from 29 to 57 years.
Diagnostics
Background: To evaluate the prevalence of Müllerian anomalies (MAs) in a cohort of infertile Mexican women candidates for infertility treatments (intrauterine insemination or IVF (In vitro fertilization) cycles). Methods: We performed a retrospective observational study on a cohort of consecutive women, who underwent hysteroscopy and laparoscopy as part of the basic infertility workup from 2002 to 2014, at our center. Our aim was to calculate the prevalence of MAs and each subtype. Results: A total of 4005 women were included in the study. The MA prevalence was 4.4% (95% CI; 3.8–5.1; n = 177). Among women with MAs, the prevalence of different MA types was: septate uterus 54.2% (n = 96), arcuate uterus 15.8% (n = 28), bicornuate uterus 10.7% (n = 19), unicornuate uterus 8.5% (n = 15), didelphys uterus 6.2% (n = 11) and hypoplasia/agenesis 3.4% (n = 6), unclassifiable 1.1% (n = 2). Women with MAs who achieved pregnancy were: 33.3% (n = 59). The MA associated with the highest pregnancy...
Pregnancy following laparoscopic myomectomy: preliminary results
Human Reproduction, 1999
The objective of this study was to assess the outcome of pregnancy in a series of women who underwent laparoscopic myomectomy. A total of 115 women underwent laparoscopic myomectomy for pressure and pain (76.5%), abnormal bleeding (52.2%) and/or infertility (29.6%). Follow up data were obtained either by reviewing the patient's chart or returned questionnaire. Of the 115 women, there were 42 pregnancies in 31 patients. Two women were lost to follow-up. Of the remaining 40 pregnancies, six ended with vaginal delivery at term. Caesareans were performed in 22 cases, including 21 at term and one at 26 weeks gestation. Two pregnancies were associated with a normal delivery, but the mode of delivery is unknown. Eight resulted in first trimester pregnancy loss, one was an ectopic pregnancy, and one patient underwent elective termination. Spontaneous uterine rupture was not noted during pregnancy or at term in any of the cases. Average length of follow-up from the date of surgery was 43 months, with a range of 9-99 months. Our series did not confirm the hypothesis that laparoscopic myomectomy is associated with an increased risk for uterine dehiscence during pregnancy. However, a larger series is needed to make a conclusive judgement.
JBRA Assisted Reproduction, 2021
Objective: To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. Methods: Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. Results: 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979). Conclusions: The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.
Determinants of reproductive outcome after abdominal myomectomy for infertility
Fertility and Sterility, 1999
To determine the effect of myomectomy as a therapy for infertility and to define the factors that influence reproductive outcome. Design: Retrospective study of a case series. Setting: An academic department specializing in conservative surgery. Patient(s): A total of 138 infertile women who underwent first-line conservative surgical treatment at laparotomy for uterine leiomyomas over an 8-year period. Intervention(s): Data were collected on baseline clinical characteristics, surgical details, and subsequent reproductive history. Main Outcome Measure(s): Cumulative pregnancy rates at 24 months according to selected clinical and fibroid characteristics. Result(s): Pregnancy occurred in 76 women. The 24-month cumulative probability of conception according to the Kaplan-Meier method was 87% in patients Ͻ30 years of age, 66% in patients 30-35 years of age, and 47% in patients Ͼ35 years of age. The pregnancy rates in women with and without minor infertility factors in addition to myomas were 56% and 71%, respectively, and those in women with Ͻ2 years versus Ն2 years of infertility were 84% and 51%, respectively. The size and site of the largest myoma and the total number of tumors removed did not influence the outcome. Conclusion(s): Our results suggest a benefit of myomectomy in infertile patients. However, women should be counseled carefully before surgery because the determinants of outcome appear to be independent of treatment.
Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010
The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. Methods: The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. Results: The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained postoperative death. Conclusions: Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas.
Mini-invasive Surgery, 2020
Aim: We aimed to evaluate the feasibility of single-port laparoscopic myomectomy in the virgin womb. Methods: A retrospective chart review of 31 consecutive cases between November 2017 and October 2019 performed by a single surgeon was performed. Results: The mean age of patient was 50.10 ± 7.79 years old. The mean BMI was 23.55 ± 4.36 kg/m 2. The mean number of myoma in single patient was 3.84 ± 2.45 pieces. The mean maximum diameter of myoma in single patient was 11.24 ± 3.27 cm. The mean operation time was 182.32 ± 52.39 min. The mean blood loss was 231.77 ± 238.90 mL. The Visual Analogue Score (VAS) of pain when immediately arriving at the ward after operation was 2.32 ± 1.60. The VAS after 24 h dropped to 1.23 ± 1.43. In total, 119 myomas were removed in our study. There were 15 (48.4%) women with more than four myomas. Fifteen (48.4%) women had more than two myomas that were > 5 cm. There were 58 (48.74%) intramural myomas, with mean diameter of 6.72 ± 4.41 cm. Fifty-two (43.70%) subserous type myoma were removed with mean diameter 2.58 ± 3.35 cm. Posterior myoma accounted for five (4.20%) pieces with mean diameter of 9.30 ± 4.49 cm. The broad ligament type myoma accounted for four pieces (3.36%), and the mean diameter was 3.74 ± 1.87 cm. There were 51 (42.9%) myomas > 5 cm in diameter. Among the different types of myoma, there were 36 (62.1%) intramural type and 6 (11.5%) subserous type, and all posterior and broad ligament type were > 5 cm in diameter. The blood loss and operation time showed no relationship to myoma number. There were differences in blood loss (P = 0.0359) and operation time (P = 0.0537) based on the maximum diameter of myoma. No learning curve was noted in the cumulative sum control chart analysis of the 31 consecutive cases. Conclusion: In our 31 consecutive cases, the operation time, blood loss, and postoperative VAS score were all comparable to the previously published literature for single-port laparoscopic myomectomy. It is feasible for virgin women with symptomatic myoma to receive single-port laparoscopic myomectomy.