- Email: [email protected]
Laparoscopic Management of Huge Cervical Myoma
Accepted Manuscript Laparoscopic management of huge cervical myoma Nuri Peker, M.D, Savaş Gundogan, M.D, Fatih Şendağ, M.D
PII:
S1553-4650(16)31042-1
DOI:
10.1016/j.jmig.2016.09.002
Reference:
JMIG 2947
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 14 August 2016 Accepted Date: 3 September 2016
Please cite this article as: Peker N, Gundogan S, Şendağ F, Laparoscopic management of huge cervical myoma, The Journal of Minimally Invasive Gynecology (2016), doi: 10.1016/j.jmig.2016.09.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Laparoscopic management of huge cervical myoma
Nuri Peker, M.D Savaş Gundogan M.D
RI PT
Fatih Şendağ, M.D
İstanbul, Turkey
Author for correspondence: Dr. Nuri Peker [email protected]
SC
Acibadem University Atakent Hospital, Department of Obstetrics and Gynecology,
Department of Gynecology and Obstetrics, Acibadem University, İstanbul
Post code: 34000, İstanbul, Turkey Phone Number: 905072352921
M AN U
Merkez mahallesi, Turgut Özal Bulvarı, Halkalı
The authors have no conflict of interest
AC C
EP
TE D
Local ethic committee approved the study and consent was obtained from the patient.
ACCEPTED MANUSCRIPT Abstract Study Objective To present the feasibility of laparoscopic management of huge cervical myoma
Step by step explanation of the surgery using video Setting
RI PT
Design
SC
Uterine fibroids are the most common benign neoplasm of the female reproductive
tract with the estimated incidence of 25-30% at reproductive age. Patients generally
M AN U
have no symptoms however patients those have symptoms such as severe pelvic pain, heavy uterine bleeding or infertility may undergo surgery. The traditional management is surgery however uterine artery embolization, hormonal therapy using GnRH (Gonadotropin-Releasing Hormone) agonists or SERM (Selective Estrogen Receptor Modulator) should be preferred as the medical approach.
TE D
Surgical management should be performed via laparoscopy or laparotomy however laparoscopic myomectomy is being a debate at patients with huge myomas. Difficulties at excision, removal and the repair of myometrial defect, increased operative time and blood loss keep the physicians away from laparoscopic
AC C
EP
myomectomy.
Case report
A 40-year-old gravida 0 para 0 woman was admitted to our clinic with the complaint of chronic pelvic pain, dyspareunia and infertility. Past history was unremarkable. At ultrasonographic examination, a 14* 10 cm fibroid settled on the cervical region was detected. On bimanual exam, an immobile solid mass originated from uterine cervix and filling the pouche of douglas was palpated. The patient was informed of the findings and was recommended laparoscopic myomectomy because of her fertility desire. At abdominopelvic examination, a huge fibroid fulfilled and enlarged the cervix was observed. A myomectomy was performed using the standard technique as
ACCEPTED MANUSCRIPT described elsewhere. A transvers incision was made by harmonic scalpel. The myoma was fixed with corkscrew and was enucleated. After bleeding control the myoma bed was filled with spongostanTM in order to prevent possible bleeding like leakage. Due to the anatomical structure of cervical region, the incision was closed monolayer with ‘0’ vicryl. The total intraoperative blood loss was 300 mL, the total weight of myoma
RI PT
was 670 g and the operation was lasted about 140 minutes. There was no intraoperative complication. She was discharged at postoperative 1st day and did not experience any problems at fallow up. The final histopathological
SC
examination confirmed the diagnosis of uterine leiomyoma.
M AN U
Conclusion
In conclusion, laparoscopic management of huge fibroids at difficult locations such as cervical region seems to be a safe and feasible option especially in the experienced hands.
TE D
Keywords: cervical myoma, laparoscopy, myomectomy,
References
1- Sinha R(1), Sundaram M, Lakhotia S, Hegde A. Cervical myomectomy with
EP
uterine artery ligation at its origin. J Minim Invasive Gynecol. 2009 SepOct;16(5):604-8.
AC C
2- Buckley VA(1), Nesbitt-Hawes EM(2), Atkinson P(2), Won HR(2), Deans R(2), Burton A(3), Lyons SD(2), Abbott JA(2). Laparoscopic myomectomy: clinical outcomes and comparative evidence. J Minim Invasive Gynecol. 2015 Jan; 22(1):1125.
3- Saccardi C(1), Gizzo S, Noventa M, Ancona E, Borghero A, Litta PS. Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience. Arch Gynecol Obstet. 2014 Nov;290(5):951-6.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
PII:
S1553-4650(16)31042-1
DOI:
10.1016/j.jmig.2016.09.002
Reference:
JMIG 2947
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 14 August 2016 Accepted Date: 3 September 2016
Please cite this article as: Peker N, Gundogan S, Şendağ F, Laparoscopic management of huge cervical myoma, The Journal of Minimally Invasive Gynecology (2016), doi: 10.1016/j.jmig.2016.09.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Laparoscopic management of huge cervical myoma
Nuri Peker, M.D Savaş Gundogan M.D
RI PT
Fatih Şendağ, M.D
İstanbul, Turkey
Author for correspondence: Dr. Nuri Peker [email protected]
SC
Acibadem University Atakent Hospital, Department of Obstetrics and Gynecology,
Department of Gynecology and Obstetrics, Acibadem University, İstanbul
Post code: 34000, İstanbul, Turkey Phone Number: 905072352921
M AN U
Merkez mahallesi, Turgut Özal Bulvarı, Halkalı
The authors have no conflict of interest
AC C
EP
TE D
Local ethic committee approved the study and consent was obtained from the patient.
ACCEPTED MANUSCRIPT Abstract Study Objective To present the feasibility of laparoscopic management of huge cervical myoma
Step by step explanation of the surgery using video Setting
RI PT
Design
SC
Uterine fibroids are the most common benign neoplasm of the female reproductive
tract with the estimated incidence of 25-30% at reproductive age. Patients generally
M AN U
have no symptoms however patients those have symptoms such as severe pelvic pain, heavy uterine bleeding or infertility may undergo surgery. The traditional management is surgery however uterine artery embolization, hormonal therapy using GnRH (Gonadotropin-Releasing Hormone) agonists or SERM (Selective Estrogen Receptor Modulator) should be preferred as the medical approach.
TE D
Surgical management should be performed via laparoscopy or laparotomy however laparoscopic myomectomy is being a debate at patients with huge myomas. Difficulties at excision, removal and the repair of myometrial defect, increased operative time and blood loss keep the physicians away from laparoscopic
AC C
EP
myomectomy.
Case report
A 40-year-old gravida 0 para 0 woman was admitted to our clinic with the complaint of chronic pelvic pain, dyspareunia and infertility. Past history was unremarkable. At ultrasonographic examination, a 14* 10 cm fibroid settled on the cervical region was detected. On bimanual exam, an immobile solid mass originated from uterine cervix and filling the pouche of douglas was palpated. The patient was informed of the findings and was recommended laparoscopic myomectomy because of her fertility desire. At abdominopelvic examination, a huge fibroid fulfilled and enlarged the cervix was observed. A myomectomy was performed using the standard technique as
ACCEPTED MANUSCRIPT described elsewhere. A transvers incision was made by harmonic scalpel. The myoma was fixed with corkscrew and was enucleated. After bleeding control the myoma bed was filled with spongostanTM in order to prevent possible bleeding like leakage. Due to the anatomical structure of cervical region, the incision was closed monolayer with ‘0’ vicryl. The total intraoperative blood loss was 300 mL, the total weight of myoma
RI PT
was 670 g and the operation was lasted about 140 minutes. There was no intraoperative complication. She was discharged at postoperative 1st day and did not experience any problems at fallow up. The final histopathological
SC
examination confirmed the diagnosis of uterine leiomyoma.
M AN U
Conclusion
In conclusion, laparoscopic management of huge fibroids at difficult locations such as cervical region seems to be a safe and feasible option especially in the experienced hands.
TE D
Keywords: cervical myoma, laparoscopy, myomectomy,
References
1- Sinha R(1), Sundaram M, Lakhotia S, Hegde A. Cervical myomectomy with
EP
uterine artery ligation at its origin. J Minim Invasive Gynecol. 2009 SepOct;16(5):604-8.
AC C
2- Buckley VA(1), Nesbitt-Hawes EM(2), Atkinson P(2), Won HR(2), Deans R(2), Burton A(3), Lyons SD(2), Abbott JA(2). Laparoscopic myomectomy: clinical outcomes and comparative evidence. J Minim Invasive Gynecol. 2015 Jan; 22(1):1125.
3- Saccardi C(1), Gizzo S, Noventa M, Ancona E, Borghero A, Litta PS. Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience. Arch Gynecol Obstet. 2014 Nov;290(5):951-6.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT