Pregnancy outcome after laparoscopic and laparoconverted myomectomy (original) (raw)
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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.
Reproductive Outcome after Laparoscopic Myomectomy for Intramural Fibroids in Infertility Women
2020
Background: Myomectomy is the recommended treatment for symptomatic uterine fibroids when women wish to preserve their fertility. The role of infertility and intramural fibroids are controversial. The aim of the present study was to assess the infertility results and pregnancy outcome in infertile patients with or without associated infertility factors who underwent laparoscopic myomectomy of large intramural myoma and to assess the safety of laparoscopic myomectomy in infertility patients. Methods: 35 infertile patients who underwent laparoscopic myomectomy for intramural fibroid measuring more than 30 mm in diameter were studied from January 2017 to December 2017. Their fertility and pregnancy outcome were studied for 24 months post laparoscopic myomectomy. Results: 23 patients became pregnant (65.5%). The mean delay in conception was 7±2.9 months. Nearly 34.7% of the women conceived spontaneously, 34.7% conceived by IUI and the remaining 30.43% by IVF.Among23 pregnancies 17 live ...
Laparoscopic Myomectomy: Clinical Outcomes and Comparative Evidence
Journal of Minimally Invasive Gynecology, 2015
Laparoscopic myomectomy is a common surgical treatment for symptomatic uterine leiomyomas. Proponents of the laparoscopic approach to myomectomy propose that the advantages include shorter length of hospital stay and recovery time. Others suggest longer operative time, greater blood loss, increased risk of recurrence, risk of uterine rupture in future pregnancies, and potential dissemination of cells with use of morcellation. This review outlines techniques for performance of laparoscopic myomectomy and critically appraises the available evidence for operative data, short-term and long-term complications, and reproductive outcomes.
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.
Predisposing factors for fibroids and outcome of laparoscopic myomectomy in infertility
Journal of Gynecological Endoscopy and Surgery, 2009
Introduction: Fibroids are very common tumors affecting women for centuries, however surprising that no signifi cant data is still available as to what could be the cause of fi broid? What could be the predisposing or risk factors? Does it has any impact on fertility? Outcomes of Laparoscopic myomectomy in infertility? Setting: Advanced Tertiary Gynecologic endoscopic unit. Aims and Objectives: 1) What are the predisposing factors to develop fi broids? 2) Do fi broids lead to infertility? 3) What are the indications for removal of fi broids in infertility? 4) Is laparoscopic surgery better than open surgery? 5) Is the risk of rupture uterus more after laparoscopic myomectomy? 6) What is the success in terms of pregnancy rate after myomectomy? 7) What are the chances of abortions with or without myomectomy? Materials and Methods: A retrospective research study was carried out on 2540 women at the National Institute of Laser and Endoscopic Surgery and Aakar IVF Centre, Mumbai, a referral centre in India. This study was done over a period of 14 years. Women varied in age from 23 to 51 years and infertility of at least more than three years. The woman had fi broids from one to seventeen in number and two centimeters to eighteen centimeters in size which were either submucous, intramural, serosal, cervical or broad ligament. The women requiring hysteroscopic myoma resection were excluded in this study and Laparoscopic myomectomy done in woman other than infertility are also excluded from the study. Results: During the course of our study we found that the diet, weight, hypertension, habits had a bearing on incidence of fi broid. In one of the most promising research fact we found that fi broids itself produce prolactin and due to three times high level of aromatase had higher level of estradiol locally compared to normal myometrium. This was detrimental to fertility. A mild elevation of blood levels of prolactin usually in the range of 40-60 ng/ml was noticed in nearly 42% of the cases. Fibroids with infertility as a major complaint along with excessive vaginal bleeding in 33%, pain abdomen and dysmenorhea 10%, pressure symptoms in 3%, accidental fi nding of a large mass in 5% were the major indications for laparoscopic myomectomy. The pregnancy rate after removal of fi broids with active fertility treatment was 42 % and in donor oocyte IVF was 50%, abortion rate was 5%, 64% LSCS, 31% vaginal deliveries. There was no scar rupture in all pregnancies post laparoscopic myomectomy. Conclusion: Presence of fi broids in fi rst degree female relative, predominantly red meat eating women, excess weight and high Blood pressure increased incidence of fi broids. Pregnancies & oral contraceptives decreased chances of fi broids. In infertile patient fi broids of signifi cant size, multiple, had high local prolactin & aromatase level affecting fertility. Laparoscopic removal of fi broids increased pregnancy rate to 37.2% & 50% in donor oocyte IVF.
Fertility and Sterility, 2007
Objective: To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive. Design: Randomized controlled trial. Setting: Departments of obstetrics and gynecology of the universities of Catanzaro, Rome, and Florence, Italy. Patient(s): One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility. Intervention(s): Laparoscopic and minilaparotomic myomectomy. Main Outcome Measure(s): Pregnancy, abortion, and live-birth rates. Result(s): Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy, live-birth, and abortion rates, whereas pregnancy and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group. Categorizing the patients according to surgical indication for myomectomy, cumulative pregnancy rate, pregnancy, and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients, whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility. Conclusion(s): Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility, whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas. (Fertil Steril Ò 2007;88:933-41. Ó2007 by American Society for Reproductive Medicine.)
Pregnancy Outcomes Following Laparoscopic Myomectomy
World Journal of Laparoscopic Surgery With Dvd, 2008
Background: The laparoscopic approach to myomectomy has raised questions about the risk of uterine rupture in patients who become pregnant following surgery. It has been suggested that the rupture outside labor in pregnancies following laparoscopic myomectomy can be due to the difficulty of suturing or to the presence of a hematoma or to the wide use of radiofrequencies.
Pregnancy Outcomes and Deliveries after Laparoscopic Myomectomy
The Journal of the American Association of Gynecologic Laparoscopists, 2003
In the view of its benefits and low risk of complications, 1-3 laparoscopic myomectomy (LM) is an effective alternative to laparotomic myomectomy, although it is technically demanding even for skilled laparoscopists. Four case reports of spontaneous uterine rupture 4-7 during pregnancy in women conceiving after LM raise questions concerning the safety of this technique, specifically, the adequacy of laparoscopic suturing of myometrium in patients who desire future pregnancy. To date there are few significant data about pregnancy outcomes and deliveries after LM. Only two published series 8,9 had study populations of more than 65 pregnancies, with 57 and 100 deliveries, respectively. Materials and Methods Institutional review board permission was not considered necessary as treatment and study end points were similar to our usual clinical practice. We assessed pregnancy outcomes and deliveries in 359 patients who underwent LM, with removal of 768 myomas. Main indications for surgery were pelvic mass, abnormal uterine bleeding, pelvic pain, and infertility. 3 A detailed description of our surgical technique is available elsewhere. 3 Briefly, three suprapubic access ports were employed. Dilute Ornitine-8-vasopressin (POR 8; Sandoz, Berne, Swit-zerland) was injected into several sites, followed by a longitudinal incision of the most distended part of myometrium down to the pseudocapsule with unipolar hook or scissors. After the cleavage plane was identified, the myoma was enucleated by means of adequate traction with a myoma drill and countertraction with a strong grasper and suctionirrigator. Laparoscopic closure of the myometrial wound was performed in one, two, or, exceptionally, three layers depending on the depth of the myoma. Interrupted sutures of braided-coated polyglycolic acid 0 or 2/0 were primarily used. Hemostasis was fundamentally achieved with endoscopic suturing, with bipolar coagulation used only for significant bleeders. No adhesion-prevention mechanism was employed. Antibiotics were given prophylactically just before surgery and postoperatively every time the uterine cavity was opened. Patients were discharged on postoperative day 2, after two-dimensional endovaginal sonographic assessment of the uterine scar. A waiting period of 6 to 8 months before attempting to conceive was recommended depending on the surgeon's assessment of uterine wound healing. No particular recommendations were made concerning type of delivery after LM. Follow-up ranged from 25 to 41 months (average 35 mo). Using telephone questionnaire, we collected the following data for each woman: one or more pregnancies since surgery, time between myomectomy and conception, 177
Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy
Fertility and Sterility, 2006
Objective: To assess the risks and outcome of pregnancies and deliveries after laparoscopic myomectomy (LM). Design: Retrospective study. Patient(s): A total of 514 patients of fertile age that underwent LM at the Center were selected. Intervention(s): All the surgical procedures were performed using the same technique employing a vertical uterine incision and avoiding the use of electrosurgery. Main Outcome Measure(s): Number and outcome of pregnancies achieved after surgery, abortion rate, preterm delivery, gestational age, malpresentation, spontaneous or cesarean delivery, and postpartum hemorrhage. We also paid particular attention to the occurrence of uterine rupture.
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.