How to manage multiple fibroids in reproductive laparoscopic surgery
The incidence of fibroids ranges from 30% to 70% in women of reproductive age, with the peak incidence occurring between 35 and 49 years of age. Risk factors for fibroids include nulliparity, obesity, black ethnicity, family history, polycystic ovarian syndrome, diabetes, and hypertension. Fibroids...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2013-11-01
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| Series: | Gynecology and Minimally Invasive Therapy |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213307013000993 |
| _version_ | 1819022231143972864 |
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| author | Wachyu Hadisaputra Arie Aldila Pratama |
| author_facet | Wachyu Hadisaputra Arie Aldila Pratama |
| author_sort | Wachyu Hadisaputra |
| collection | DOAJ |
| description | The incidence of fibroids ranges from 30% to 70% in women of reproductive age, with the peak incidence occurring between 35 and 49 years of age. Risk factors for fibroids include nulliparity, obesity, black ethnicity, family history, polycystic ovarian syndrome, diabetes, and hypertension. Fibroids are present in 5–10% of the patients presenting with infertility. Laparoscopic myomectomy is preferred over abdominal myomectomy because several small incisions are used rather than one larger incision. Related to the small incisions, recuperation is usually associated with minimal discomfort. Women with infertility and fibroids become pregnant after myomectomy in approximately 50% of cases. The pregnancy rate in patients undergoing hysteroscopic and laparoscopic/abdominal myomectomy is 45–49%. Laparoscopic myomectomy is a technically challenging procedure with surgeon-specific limitations. Preoperative treatments with gonadotropin-releasing hormone have been shown to reduce blood loss and shorten operative time. The consensus states that the maximal size must be 8–10 cm and the total number of fibroids should not exceed four. It is important not to perform laparoscopic myomectomies with more than 5–7 large fibroids because in these cases, the procedure is excessively time-consuming and gives the surgeon opportunities to miss the smaller fibroids after the uterus has been incised and repaired in too many places. The role of vasoconstrictors such as vasopressin, epinephrine, and ornipressin help with the control of bleeding from the incised sites. Temporary clipping of the uterine artery is an effective procedure in reducing hemoglobin loss during laparoscopic myomectomy. |
| first_indexed | 2024-12-21T04:19:42Z |
| format | Article |
| id | doaj.art-316548f11ec34a478dda0db69cf0239a |
| institution | Directory Open Access Journal |
| issn | 2213-3070 |
| language | English |
| last_indexed | 2024-12-21T04:19:42Z |
| publishDate | 2013-11-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Gynecology and Minimally Invasive Therapy |
| spelling | doaj.art-316548f11ec34a478dda0db69cf0239a2022-12-21T19:16:12ZengWolters Kluwer Medknow PublicationsGynecology and Minimally Invasive Therapy2213-30702013-11-012411011310.1016/j.gmit.2013.07.004How to manage multiple fibroids in reproductive laparoscopic surgeryWachyu Hadisaputra0Arie Aldila Pratama1Reproductive Health Division, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Indonesia/Dr. Cipto Mangunkusumo National General Hospital, Jakarta, IndonesiaIndonesian Gynecological Endoscopy Society, Jakarta, IndonesiaThe incidence of fibroids ranges from 30% to 70% in women of reproductive age, with the peak incidence occurring between 35 and 49 years of age. Risk factors for fibroids include nulliparity, obesity, black ethnicity, family history, polycystic ovarian syndrome, diabetes, and hypertension. Fibroids are present in 5–10% of the patients presenting with infertility. Laparoscopic myomectomy is preferred over abdominal myomectomy because several small incisions are used rather than one larger incision. Related to the small incisions, recuperation is usually associated with minimal discomfort. Women with infertility and fibroids become pregnant after myomectomy in approximately 50% of cases. The pregnancy rate in patients undergoing hysteroscopic and laparoscopic/abdominal myomectomy is 45–49%. Laparoscopic myomectomy is a technically challenging procedure with surgeon-specific limitations. Preoperative treatments with gonadotropin-releasing hormone have been shown to reduce blood loss and shorten operative time. The consensus states that the maximal size must be 8–10 cm and the total number of fibroids should not exceed four. It is important not to perform laparoscopic myomectomies with more than 5–7 large fibroids because in these cases, the procedure is excessively time-consuming and gives the surgeon opportunities to miss the smaller fibroids after the uterus has been incised and repaired in too many places. The role of vasoconstrictors such as vasopressin, epinephrine, and ornipressin help with the control of bleeding from the incised sites. Temporary clipping of the uterine artery is an effective procedure in reducing hemoglobin loss during laparoscopic myomectomy.http://www.sciencedirect.com/science/article/pii/S2213307013000993FertilityLaparoscopic myomectomyMultiple fibroidsVasoconstrictor |
| spellingShingle | Wachyu Hadisaputra Arie Aldila Pratama How to manage multiple fibroids in reproductive laparoscopic surgery Gynecology and Minimally Invasive Therapy Fertility Laparoscopic myomectomy Multiple fibroids Vasoconstrictor |
| title | How to manage multiple fibroids in reproductive laparoscopic surgery |
| title_full | How to manage multiple fibroids in reproductive laparoscopic surgery |
| title_fullStr | How to manage multiple fibroids in reproductive laparoscopic surgery |
| title_full_unstemmed | How to manage multiple fibroids in reproductive laparoscopic surgery |
| title_short | How to manage multiple fibroids in reproductive laparoscopic surgery |
| title_sort | how to manage multiple fibroids in reproductive laparoscopic surgery |
| topic | Fertility Laparoscopic myomectomy Multiple fibroids Vasoconstrictor |
| url | http://www.sciencedirect.com/science/article/pii/S2213307013000993 |
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