Myoma;Uterus
Conditions
Keywords
Laparoscopy, Power morcellation, Transvaginal extraction
Brief summary
Laparoscopic myomectomy represents the fertility-sparing gold standard approach for the management of subserosal and intramural uterine myomas: this technique allows faster recovery, less complications and improved surgical outcomes than laparotomy. Despite these validated cornerstones of minimally invasive gynecology, the best approach for specimen retrieval is still debated. Among these approaches, surgical specimen retrieval after laparoscopic myomectomy could be performed by mini-laparotomy, by power morcellation using morcellator inserted through one of the ancillary trocars, or by transvaginal extraction through an endobag inserted at level of the posterior vaginal fornix (between the utero-sacral ligaments). Unfortunately, mini-laparotomy has poor esthetic outcome and does not conform the current standards of minimally invasive surgery. In addition, on 24 November 24 2014 the Food and Drug Administration updated a Safety Communication about Power Morcellation, warning against the use of laparoscopic power morcellators in the majority of women undergoing myomectomy or hysterectomy for treatment of fibroids, due to the risk of spreading an unsuspected uterine sarcoma within the abdomen and pelvis. Considering this scenario, transvaginal extraction may represents a feasible approach for specimen retrieval. In this view, the current study aims to retrospectively compare surgical outcomes in women that underwent laparoscopic myomectomy with subsequent power morcellation (before the issuing of the abovementioned Safety Communication by the Food and Drug Administration) or transvaginal extraction (after the issuing of the abovementioned Safety Communication by the Food and Drug Administration) of the surgical specimens.
Interventions
DEVICEPower morcellation
Power morcellation of surgical specimens after laparoscopic myomectomy.
PROCEDURETransvaginal extraction
Transvaginal extraction of surgical specimens after laparoscopic myomectomy.
Sponsors
Università degli Studi dell'Insubria
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 45 Years
Healthy volunteers
No
Inclusion criteria
* Women affected by single or multiple uterine myomas. * Signed informed consent.
Exclusion criteria
* Human papilloma virus-related pathologies at pap-smear within the 12 months preceding surgery. * Women with obliteration of the cul-de-sac. * Women with the suspected cancer of gynecological origin. * Women who had never experienced complete sexual intercourse before the operation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Complication rate | Within 12 months after surgery. | Number of surgical complications (Clavien-Dindo Classification) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Operative time | Through study completion, an average of 10 years (retrospective analysis) | Duration of the surgery, expressed in minutes. |
| Blood loss | Through study completion, an average of 10 years (retrospective analysis) | Blood loss during the surgery, expressed in milliliters (ml). |
| Hospital stay | Through study completion, an average of 10 years (retrospective analysis) | Duration of the hospitalization, expressed in days |
| Sexual function | 6 and 12 months after surgery. | Sexual function evaluated by Female Sexual Function Index questionnaire, investigating quantity and quality of sex \[scale total score minimum: 2 (worse outcome), maximum: 36 (best outcome)\] |
Contacts
Primary ContactAntonio Simone Laganà, M.D.
Outcome results
None listed