Intraligamental Myomectomy Strategy Using Laparoscopy

Pei Shen Huang, Bor Ching Sheu, Su Cheng Huang, Wen Chun Chang

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Study Objective Intraligamental myomas (IMs) represent 6% to 10% of all uterine myomas. An IM growing from the lateral uterine wall into the broad ligament often presents as a large pelvic mass without symptoms. Removing a large IM can be difficult because of the limited operative field and poses challenges during conventional laparoscopic surgical approaches. The risk of injury to the ureter and uterine artery during myomectomy is greater than that during other types of myoma. Design Retrospective study (Canadian Task Force classification III). Setting University-affiliated hospital. Patients IM was classified into 3 types according to the location: (1) anterior intraligamental myoma (AIM), (2) posterior intraligamental myoma (PIM), and (3) lateral intraligamental myoma (LIM). From April 2007 to July 2015, 83 consecutive patients with IM underwent laparoscopic myomectomy at National Taiwan University Hospital, Taipei, Taiwan, including 23 AIM, 27 PIM, and 33 LIM. Interventions Several techniques are described, and videos are supplied for performing laparoscopic myomectomy safely and easily in different types of IM. Measurements and Main Results Urinary frequency (31%) and a palpable abdominal mass (31%) were the 2 most common presenting symptoms. Most of the lesions were 33 LIM (40%) followed by 27 PIM (32%) and 23 AIM (28%). The mean myoma sizes were 11.0, 8.0, and 7.8 cm; the mean myoma weights were 478, 279, and 309 g; the mean operative times were 134, 108, and 104 minutes; and the mean blood loss during surgery was 224, 94, and 107 mL for LIM, PIM, and AIM, respectively. LIMs had relatively more blood loss because they were heavier and commonly rested alongside the uterine artery. The only complication was late postoperative hemorrhage in 1 case of LIM. Histopathology showed leiomyoma in all cases. Three patients were spontaneously conceived after myomectomy, and each had a successful pregnancy and cesarean delivery. Conclusion Surgical treatment of IM is empirically difficult. It is important to use an approach that considers the location, size, and shape of the myoma. All types of IM presented with similar symptoms, and the highest blood loss occurred during laparoscopic myomectomy of a LIM.

Original languageEnglish
Pages (from-to)954-961
Number of pages8
JournalJournal of Minimally Invasive Gynecology
Volume23
Issue number6
DOIs
Publication statusPublished - Sep 1 2016
Externally publishedYes

Fingerprint

Uterine Myomectomy
Myoma
Laparoscopy
Uterine Artery

Keywords

  • Classification
  • Huge myoma
  • Intraligamental myoma
  • Laparoscopic myomectomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Intraligamental Myomectomy Strategy Using Laparoscopy. / Huang, Pei Shen; Sheu, Bor Ching; Huang, Su Cheng; Chang, Wen Chun.

In: Journal of Minimally Invasive Gynecology, Vol. 23, No. 6, 01.09.2016, p. 954-961.

Research output: Contribution to journalArticle

Huang, Pei Shen ; Sheu, Bor Ching ; Huang, Su Cheng ; Chang, Wen Chun. / Intraligamental Myomectomy Strategy Using Laparoscopy. In: Journal of Minimally Invasive Gynecology. 2016 ; Vol. 23, No. 6. pp. 954-961.
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N2 - Study Objective Intraligamental myomas (IMs) represent 6% to 10% of all uterine myomas. An IM growing from the lateral uterine wall into the broad ligament often presents as a large pelvic mass without symptoms. Removing a large IM can be difficult because of the limited operative field and poses challenges during conventional laparoscopic surgical approaches. The risk of injury to the ureter and uterine artery during myomectomy is greater than that during other types of myoma. Design Retrospective study (Canadian Task Force classification III). Setting University-affiliated hospital. Patients IM was classified into 3 types according to the location: (1) anterior intraligamental myoma (AIM), (2) posterior intraligamental myoma (PIM), and (3) lateral intraligamental myoma (LIM). From April 2007 to July 2015, 83 consecutive patients with IM underwent laparoscopic myomectomy at National Taiwan University Hospital, Taipei, Taiwan, including 23 AIM, 27 PIM, and 33 LIM. Interventions Several techniques are described, and videos are supplied for performing laparoscopic myomectomy safely and easily in different types of IM. Measurements and Main Results Urinary frequency (31%) and a palpable abdominal mass (31%) were the 2 most common presenting symptoms. Most of the lesions were 33 LIM (40%) followed by 27 PIM (32%) and 23 AIM (28%). The mean myoma sizes were 11.0, 8.0, and 7.8 cm; the mean myoma weights were 478, 279, and 309 g; the mean operative times were 134, 108, and 104 minutes; and the mean blood loss during surgery was 224, 94, and 107 mL for LIM, PIM, and AIM, respectively. LIMs had relatively more blood loss because they were heavier and commonly rested alongside the uterine artery. The only complication was late postoperative hemorrhage in 1 case of LIM. Histopathology showed leiomyoma in all cases. Three patients were spontaneously conceived after myomectomy, and each had a successful pregnancy and cesarean delivery. Conclusion Surgical treatment of IM is empirically difficult. It is important to use an approach that considers the location, size, and shape of the myoma. All types of IM presented with similar symptoms, and the highest blood loss occurred during laparoscopic myomectomy of a LIM.

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