Abstract:
STUDY OBJECTIVE:To describe the perioperative outcomes of various modes of myomectomy (abdominal [AM], laparoscopic [LM], or robotic [RM]) in cases of extreme myoma burden. DESIGN:Retrospective cohort study (Canadian Task Force classification II-2). SETTING:A tertiary academic center in Boston, Massachusetts. PATIENTS:All women who underwent an AM, LM, or RM for extreme myoma burden, defined as representing the upper quartile for specimen weight (≥434.6 g) or myoma count (≥7 myomas), between 2009 and 2016. INTERVENTIONS:Baseline demographics and perioperative outcomes were collected from review of medical records, including estimated blood loss, operative time, length of stay, and complications. Univariate linear and logistic regression analyses were conducted. MEASUREMENTS AND MAIN RESULTS:During the study period 659 women underwent myomectomy for extreme myoma burden; 47.2% of cases were AM, 28.1% LM, and 24.7% RM. Overall myoma burden differed across the 3 routes and was greatest in the AM group (mean weight: 696.2 ± 784.5 g for AM vs 586.6 ± 426.1 g for LM and 586.6 ± 426.1 g for RM; mean number: 16.8 ± 15.0 for AM vs 7.2 ± 7.0 for LM and 6.7 ± 4.7 for RM; p <.001 for both). The 3 routes differed in operative time and length of stay, with RM having the longest operative time (mean, 239.7 minutes; p <.001) and AM the longest length of stay (mean, 2.2 ± .9 days; p <.001). Other perioperative outcomes were similar across the surgical approaches. Increasing myoma burden was associated with an increased risk of perioperative complications for all surgical approaches, with a threshold of 13 myomas associated with an almost 2-fold higher risk of perioperative complications (odds ratio, 1.77; 95% confidence interval, 1.17-2.70; p = .009). Cumulative incidence of perioperative complications with increasing specimen weight was greater in the RM cases as compared with AM (p = .002) or LM (p = .020), whereas the cumulative incidence of perioperative complications with increasing myoma count was lowest with AM compared with LM (p <.001) or RM (p <.001). CONCLUSION:Myomectomy for extreme myomas is feasible using an abdominal, laparoscopic, or robotic approach. Increased myoma burden is associated with an increased risk of perioperative complications. A threshold of 13 myomas was associated with an almost 2-fold higher risk of perioperative complications for all modes. Perioperative complication outcomes were more favorable in AM or LM over RM with increased myoma weight and AM over LM or RM with increased myoma number.
journal_name
J Minim Invasive Gynecoljournal_title
Journal of minimally invasive gynecologyauthors
Jansen LJ,Clark NV,Dmello M,Gu X,Einarsson JI,Cohen SLdoi
10.1016/j.jmig.2018.10.022subject
Has Abstractpub_date
2019-01-01 00:00:00pages
1095-1103issue
6eissn
1553-4650issn
1553-4669pii
S1553-4650(18)31343-8journal_volume
26pub_type
杂志文章abstract:STUDY OBJECTIVE:To determine the reliability of four commonly used tests to confirm the placement of the Veres needle during closed laparoscopy and their ability to determine other complications of entry. DESIGN:A prospective observational study (Canadian Task Force classification II-2). SETTING:A university-affiliat...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2005.01.011
更新日期:2005-03-01 00:00:00
abstract:STUDY OBJECTIVE:To review the changing trends in the surgical management of ectopic pregnancy and to evaluate the effect of an ongoing training program for resident surgeons on the rate and success of laparoscopic surgery. DESIGN:Retrospective chart review (Canadian Task Force classification II-3). SETTING:University...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2006.01.007
更新日期:2006-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess all electromechanical morcellators used in gynecology to achieve an objective comparison between them and to make suggestions for improvements in future developments. DESIGN:Literature review. INTERVENTION:The PubMed, Web of Science, EMBASE, and MAUDE databases were systematically searched f...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2013.12.121
更新日期:2014-05-01 00:00:00
abstract::Lymphatic complications are a common occurrence after staging surgery for early-stage ovarian cancer (eEOC). We investigated whether the introduction of minimally invasive surgery influences the risk of developing lymphoceles and lymphorrhea in patients undergoing staging for eEOC. For this purpose, data of consecutiv...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.jmig.2017.03.014
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate risk of leakage and tissue dissemination associated with various contained tissue extraction (CTE) techniques. DESIGN:In vitro study (Canadian Task Force classification: II-1). SETTING:Academic hospital simulation laboratory. INTERVENTION:Beef tongue specimens weighing 400 to 500 g were s...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2014.06.004
更新日期:2014-09-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the performance of three-dimensional (3D) ultrasound with color Doppler in the diagnosis of bladder endometriosis compared with magnetic resonance imaging (MRI) and cystoscopy. DESIGN:Canadian Task Force classification II-3. SETTING:Department of gynecology and obstetrics of a university hos...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2014.10.021
更新日期:2015-03-01 00:00:00
abstract::Cornual pregnancy is an infrequent pathological condition with severe prognosis if not adequately recognized. Ipsilateral salpingectomy represents a unique risk factor for this clinical entity. This article reports a laparoscopically treated spontaneous cornual pregnancy after homolateral salpingectomy for an earlier ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2008.11.008
更新日期:2009-03-01 00:00:00
abstract:STUDY OBJECTIVES:To evaluate the rate of intrauterine adhesions after hysteroscopic resection of hyperplastic and/or cancer areas and the efficacy of combined treatment. DESIGN:Observational retrospective study. SETTING:Patients affected by endometrial atypical hyperplasia of the endometrium or early stage endometria...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.06.004
更新日期:2015-11-01 00:00:00
abstract:STUDY OBJECTIVE:To present a modified technique for laparoscopic cornual resection for the surgical treatment of heterotopic istmocornual pregnancy. DESIGN:A step-by-step explanation of the surgery using video (Canadian Task Force Classification III-c). SETTING:Heterotopic pregnancy is the coexistence of pregnancy in...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.07.008
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To develop a new hysteroscopic morphologic scoring system that helps physicians, especially those who have less experience, to make a differential diagnosis among normal endometrium (NE), endometrial hyperplasia, and endometrial carcinoma. DESIGN:A retrospective study (Canadian Task Force Classificatio...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.02.017
更新日期:2016-07-01 00:00:00
abstract:STUDY OBJECTIVES:To compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. DESIGN:A randomized controlled trial (Canadian Task Force Classification I). SETTING:An academic hospital. PATIENTS:Forty-six women who underwent laparoscopic hyste...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jmig.2015.08.881
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:Laparoscopic uterine artery ligation may be performed during myomectomy or other uterine invasive procedures to reduce the amount of blood loss during surgery. In this video, the authors describe 3 different laparoscopic techniques to approach the uterine artery. DESIGN:Step-by-step video demonstration of 3 ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.08.026
更新日期:2020-01-01 00:00:00
abstract::Adnexal masses are a common indication for surgery in the United States. This article reviews the clinical features that may suggest an underlying malignancy, including ultrasound and biomarkers. The decision regarding how to remove an adnexal mass involves consideration of several factors, including body habitus, int...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2016.11.010
更新日期:2017-02-01 00:00:00
abstract::Heterotopic pregnancy refers to the simultaneous presence of ectopic pregnancy and intrauterine pregnancy. With the advent of assisted reproductive technology, the overall incidence of heterotopic pregnancies has risen. We report a case of a 36-year-old woman with type 2 diabetes mellitus and 1-year of primary inferti...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2019.11.003
更新日期:2020-01-01 00:00:00
abstract::Cornual, interstitial, and angular pregnancies are terms that are often used interchangeably in both the literature and clinical setting to describe various ectopic pregnancies. The diagnosis of these pregnancies can be difficult, and fear of disrupting an intrauterine pregnancy can cause hesitation during evaluation ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.08.002
更新日期:2019-01-01 00:00:00
abstract:STUDY OBJECTIVE:To demonstrate a mesh-free laparoscopic uterosacral suture sacrohysteropexy (LUSSH). DESIGN:Technical video demonstrating LUSSH for uterine prolapse (Canadian Task Force classification III). SETTING:University hospital. PATIENT:A 37-year-old woman with grade 3 uterine descent requested uterine-sparin...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.03.025
更新日期:2019-02-01 00:00:00
abstract::The radio-guided occult lesion localization (ROLL) technique has been in use since the mid-1990s, mainly in breast surgery. Today, ROLL is used for numerous oncologic pathologies, including parathyroid lesions, melanomas, and colorectal tumors. We report a patient with an 11-mm left mesorectal solitary recurrence of a...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2016.09.012
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the effect of endometrial ablation on 6 premenstrual symptoms for up to 1 year after treatment. DESIGN:Prospective cohort of 59 women awaiting endometrial ablation (Canadian Task Force classification II-2). SETTING:University tertiary care hospital. PATIENTS:Adult women of childbearing ag...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.01.023
更新日期:2015-05-01 00:00:00
abstract::Because it is minimally invasive, laparoscopic surgery is preferred over open surgery. However, it is often difficult to maintain an adequate surgical field during the procedure. As in open laparotomy, securing an adequate surgical field is important for adequate visualization. We evaluated the effectiveness and safet...
journal_title:Journal of minimally invasive gynecology
pub_type: 临床试验,杂志文章
doi:10.1016/j.jmig.2011.04.012
更新日期:2011-07-01 00:00:00
abstract::Abnormal uterine bleeding and other gynecologic complications associated with a previous cesarean section scar are only recently being identified and described. Herein we report a rare case of a woman with recurring massive uterine bleeding after 2 cesarean sections. Curettage and hormone therapy were unsuccessfully u...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2014.10.005
更新日期:2015-02-01 00:00:00
abstract:STUDY OBJECTIVE:Cervical cancer is a significant health problem in countries of the developing world. Although case series suggest advantages of total laparoscopic radical hysterectomy (TLRH) compared with total abdominal radical hysterectomy (TARH), no randomized controlled trial is currently available to establish TL...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jmig.2008.06.013
更新日期:2008-09-01 00:00:00
abstract:STUDY OBJECTIVE:To demonstrate the surgical repair of a rectovaginal fistula (RVF) using the modified Martius procedure. DESIGN:A step-by-step presentation of the procedure using video (Canadian Task Force classification III). SETTING:RVF is abnormal epithelialized connections between the vagina and rectum. Causes of...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.08.657
更新日期:2018-01-01 00:00:00
abstract:STUDY OBJECTIVE:To study the safety, feasibility, learning curve, and surgical outcome for single-port laparoscopic full staging of endometrial cancer. DESIGN:A retrospective study (Canadian Task Force classification II-3). SETTING:A university academic hospital. PATIENTS:Women with endometrial cancer undergoing sin...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2017.06.017
更新日期:2017-01-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the feasibility and safety of a McCall culdoplasty at the time of total laparoscopic hysterectomy and to evaluate the differences in the total vaginal length, vaginal apex during Valsalva, and sexual function 12 months after McCall culdoplasty compared with standard cuff closure. DESIGN:A pil...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jmig.2017.10.036
更新日期:2018-01-01 00:00:00
abstract::Excessive opioid use and misuse is a pervasive and growing societal problem, and decreasing the surgical contribution to this epidemic represents an opportunity to improve outcomes. Here we describe patterns of opioid prescription, consumption, and persistent use among women undergoing minimally invasive hysterectomy ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2018.08.024
更新日期:2019-02-01 00:00:00
abstract::Presacral and retrorectal space tumors are relatively rare lesions, the location of which can result in the onset of symptoms that are not well-defined. Retrorectal teratomas are resected to alleviate these symptoms and to rule out malignancy. Complete resection by one of the open abdominal or sacral approaches was tr...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2008.06.011
更新日期:2008-09-01 00:00:00
abstract:STUDY OBJECTIVE:Because of the rapid growth of minimally invasive surgical procedures, we developed an ultrathin fiberscopic imaging system for laser surgery that could be an important instrument for clinical use in an office setting. METHODS AND MAIN RESULTS:A new device, consisting of a custom 1.1-mm diameter flexib...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2015.04.024
更新日期:2015-09-01 00:00:00
abstract::Annual surgeon case volume has been linked to patient outcome in a variety of surgical fields, although limited data focus on gynecologic surgery performed by general gynecologists. Herein we review the literature addressing the associations between intraoperative injury, postoperative morbidity, and resource use amon...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章,评审
doi:10.1016/j.jmig.2013.03.005
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVE:To demonstrate our technique for robot-assisted laparoscopic ectopic pregnancy excision and concomitant scar revision. DESIGN:We present a stepwise narrated demonstration of our primary laparoscopic technique. SETTING:Although cesarean scar pregnancy is rare, it leads to life-threatening complications and o...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2020.06.017
更新日期:2020-06-27 00:00:00
abstract:STUDY OBJECTIVE:The objective of our study was to quantify the rate, type, and cost of interventions for uterine myomas to payers in Germany, France, and England. DESIGN:Computations using data from national hospital activity databases. DESIGN CLASSIFICATION:II-3. SETTING:Hospital admissions in Germany, France, and ...
journal_title:Journal of minimally invasive gynecology
pub_type: 杂志文章
doi:10.1016/j.jmig.2008.09.581
更新日期:2009-01-01 00:00:00