Complications and Management of Operative Methods
Gamze Yılmaz
Ankara Bilkent City Hospital, Department of Gynecology and Obstetrics, Ankara, Türkiye
Yılmaz G. Complications and Management of Operative Methods. Yavuz AF, ed. Myoma Uteri. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.117-127.
ABSTRACT
The size, number, and location of the myomas in the uterus determine the presentation and clinical consequences. A multitude of therapeutic options are available, such as expectant management, medical therapy, nonexcisional procedures, and surgery. Treatment options are determined by a number of variables, such as the characteristics of the myomas and patient, desire for future fertility, surgical skills, and patient preferences. Surgical approaches include myomectomy, hysterectomy, and, more rarely, uterine artery occlusion and radiofrequency ablation. A myomectomy is a surgical procedure that preserves the uterus while removing leiomyomas. An open abdominal, laparoscopic, hysteroscopic, or vaginal method can be used to achieve. Hysterectomy may also be appropriate for myoma treatment if patient not desire future fertility. Surgical treatments and their selections have been discussed in detail in the previous sections. In this section, specific complications for myomectomy and the management of these complications will be discussed rather than general surgical complications. Additionally, post-myomectomy pregnancy and its associated complications are addressed as a separate topic in the subsequent sections.
Keywords: Leiomyoma; Surgical Procedures; Complications
Kaynak Göster
Referanslar
- West S, Ruiz R, Parker WH. Abdominal myomectomy in women with very large uterine size. Fertil Steril. 2006 Jan;85(1):36-9. [Crossref] [PubMed]
- Iverson RE Jr, Chelmow D, Strohbehn K,Waldman L,Evantas G.E. Relative morbidity of abdominal hysterectomy and myomectomy for management of uterine leiomyomas. Obstet Gynecol 1996 Sep;88(3):415-9. [Crossref] [PubMed]
- Kim T, Purdy MP, Kendall-Rauchfuss L,Habermann E.B, Bews K, Glasgow A.E, et al. Myomectomy associated blood transfusion risk and morbidity after surgery. Fertil Steril. 2020 Jul;114(1):175-184. [Crossref] [PubMed]
- Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med 2004 Apr 5;116 Suppl 7A:58S-69S. [Crossref] [PubMed]
- Benoist S, Panis Y, Pannegeon V, Alves A,Vallaer P. Predictive factors for perioperative blood transfusions in rectal resection for cancer: A multivariate analysis of a group of 212 patients. Surgery. 2001 Apr;129(4):433-9. [Crossref] [PubMed]
- Carson JL, Duff A, Poses RM, Berlin JA, Spence RK, Trout R,Noveck H,et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996 Oct 19;348(9034):1055-60. [Crossref] [PubMed]
- Topsoee MF, Settnes A, Ottesen B, Bergholt T. A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery. Int J Gynaecol Obstet. 2017 Feb;136(2):120-127. [Crossref] [PubMed]
- Lakshmi SD, Abraham R. Role of Prophylactic Tranexamic Acid in Reducing Blood Loss during Elective Caesarean Section: A Randomized Controlled Study. J Clin Diagn Res 2016 Dec;10(12):QC17-QC21. [Crossref] [PubMed] [PMC]
- Taylor A, Sharma M, Tsirkas P, Sardo ADS, Setchell M, Magos A. Reducing blood loss at open myomectomy using triple tourniquets: a randomised controlled trial. BJOG. 2005 Mar;112(3):340-5. [Crossref] [PubMed]
- Fletcher H, Frederick J, Hardie M, Simeon D. A randomized comparison of vasopressin and tourniquet as hemostatic agents during myomectomy. Obstet Gynecol 1996 Jun;87(6):1014-8. [Crossref] [PubMed]
- Bartels C. B., Cayton KC, Chuong FS, Holthouser K,Arian SE, Abraham T, et al. An evidence-based approach to the medical management of fibroids. Clinical Obstetrics and Gynecology. 2016;59(2):p. 447. [Crossref] [PubMed]
- Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev 2011; :CD005355. [Crossref]
- Zhao F, Jiao Y, Guo Z, Hou R, Wang M. Evaluation of loop ligation of larger myoma pseudocapsule combined with va-sopressin on laparoscopic myomectomy. Fertil Steril 2011;95:762. [Crossref] [PubMed]
- Hobo R, Netsu S, Koyasu Y, Tsutsumi O. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol 2009; 113:484. [Crossref] [PubMed]
- Lurie S, Mamet Y. Transient myocardial ischemia may occur following subendometrial vasopressin infiltration. Eur J Obstet Gynecol Reprod Biol. 2000; 91:87. [Crossref] [PubMed]
- Zullo F, Palomba S, Corea D,Pellicano M, Russo T, Falbo A, et al. Bupivacaine plus epinephrine for laparoscopic myomectomy: a randomized placebo-controlled trial. Obstet Gynecol 2004; 104:243. [Crossref] [PubMed]
- LaMorte AI, Lalwani S, Diamond MP. Morbidity associated with abdominal myomectomy. Obstet Gynecol. 1993 Dec;82(6):897-900. [PubMed]
- Olufowobi O, Sharif K, Papaionnou S,Neelakantan D, Mohammed H, Afnan M. Are the anticipated benefits of myomectomy achieved in women of reproductive age? A 5-year review of the results at a UK tertiary hospital. J Obstet Gynaecol 2004. Jun;24(4):434-40.. [Crossref] [PubMed]
- Rybak EA, Polotsky AJ, Woreta T, Hailpern SM, Bristow R. Explained compared with unexplained fever in postoperative myomectomy and hysterectomy patients. Obstet Gynecol. 2008 May;111(5):1137-42. [Crossref] [PubMed]
- Viswanathan, M., Hartmann, K., McKoy, N., Stuart, G., Rankins, N., Thieda, P. et al. Management of uterine fibroids: an update of the evidence. Evidence report/technology assessment, 2007, 154: 1-122. [PubMed]
- Coyne K, Purdy MP, Bews KA,Haberman BE,Khan Z. Risk of hysterectomy at the time of myomectomy: an underestimated surgical risk. Fertil Steril 2024; 121:107. [Crossref] [PubMed]
- Osaheni O, Idehen HO, Imarengiaye CO. Analgesia for postoperative myomectomy pain: A comparison of ultrasound-guided transversus abdominis plane block and wound infiltration. Niger J Clin Pract. 2020 Nov;23(11):1523-1529. [Crossref] [PubMed]
- Sawin SW, Pilevsky ND, Berlin JA, Barnhart KT. Comparability of perioperative morbidity between abdominal myomectomy and hysterectomy for women with uterine leiomyomas. Am J Obstet Gynecol. 2000 Dec;183(6):1448-55. [Crossref] [PubMed]
- Altgassen C., Kuss S., Berger U., Löning M., Diedrich K., Schneider A. Complications in laparoscopic myomectomy. Surgical Endoscopy. 2006;20(4):614-618. [Crossref] [PubMed]
- Sizzi O, Rossetti A, Malzoni M, Minelli L,Grotta F.L, Soranna L,et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol 2007;14:453. [Crossref] [PubMed]
- Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invasive Gynecol 2008; 15:292. [Crossref] [PubMed]
- Holzer A., Jirecek S. T., Illievich U. M., Huber J., Wenzl R. J. Laparoscopic versus open myomectomy: A double-blind study to evaluate postoperative pain. Anesthesia & Analgesia. 2006;102(5):1480-1484. [Crossref] [PubMed]
- Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: A single surgeon's series of 1001 cases. Aust N Z J Obstet Gynaecol. 2010 Aug;50(4):385-90. [Crossref] [PubMed]
- Milad M. P., Milad E. A. Laparoscopic morcellator-related complications. Journal of Minimally Invasive Gynecology. 2014;21(3):486-491. [Crossref] [PubMed]
- Meulen J. F. V. D., Pijnenborg J. M. A., Boomsma C. M., Verberg M. F. G., Geomini P. M. A. J., Bongers M. Y. Parasitic myoma after laparoscopic morcellation: a systematic review of the literature. BJOG: An International Journal of Obstetrics & Gynaecology. 2016;(1):69-75. [Crossref] [PubMed]
- Ordulu Z., Dal Cin P., Chong W. W. S., Choy K.W., Lee C.,Muto M.G. et al. Disseminated peritoneal leiomyomatosis after laparoscopic supracervical hysterectomy with characteristic molecular cytogenetic findings of uterine leiomyoma. Genes, Chromosomes and Cancer. 2009;49(12):1152-1160. [Crossref] [PubMed] [PMC]
- Tanos, V., Brölmann, H., DeWilde, R. L., O'Donovan, P., Symeonidou E, Campo, R. Myoma morcellation and leiomyosarcoma panic. Gynecological Surgery, 2015, 12.1: 17-19. [Crossref]
- Pritts E. A., Parker W. H., Brown J., Olive D. L. Outcome of occult uterine leiomyosarcoma after surgery for presumed uterine fibroids: a systematic review. Journal of Minimally Invasive Gynecology. 2015;22(1):26-33. [Crossref] [PubMed]
- Cohen S. L., Einarsson J. I., Wang K. C.Brown D.,Botura D.,Scheib S.A. et al. Contained power morcellation within an insufflated isolation bag. Obstetrics & Gynecology. 2014;124(3):491-497. [Crossref] [PubMed]
- Einarsson J., Cohen S.,Fuchs N., Wang K. Inbag morcellation. Journal of Minimally Invasive Gynecology. 2014;21(6):p.S116. [Crossref] [PubMed]
- Dubuisson JB, Fauconnier A, Chapron C, G Kreiker, C Nörgaard. Second look after laparoscopic myomectomy. Hum Reprod. 998 Aug;13(8):2102-6. [Crossref] [PubMed]
- Mais V, Ajossa S, Piras B,Guerriero S.,Marongiu D., Melis G.B. Prevention of de-novo adhesion formation after laparoscopic myomectomy: a randomized trial to evaluate the effectiveness of an oxidized regenerated cellulose absorbable barrier. Hum Reprod 1995; 10:3133. [Crossref] [PubMed]
- Bulletti C, Polli V, Negrini V, E Giacomucci, C Flamigni. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1996 Aug;3(4):533-6. [Crossref] [PubMed]
- Lichtinger M, Hallson L, Calvo P, Adeboyejo G. Laparoscopic uterine artery occlusion for symptomatic leiomyomas. J Am Assoc Gynecol Laparosc. 2002 May;9(2):191-8. [Crossref] [PubMed]
- Young RJ, Puma L, Latham M, Kho KA. Radiofrequency Ablation for Treatment of Leiomyomas: Review of the Manufacturer and User Facility Device Experience (MAUDE) Database. Obstet Gynecol 2023; 142:147. [Crossref] [PubMed]
- Hald K, Kløw NE, Qvigstad E, Istre O. Laparoscopic occlusion compared with embolization of uterine vessels: a randomized controlled trial. Obstet Gynecol. 2007 Jan;109(1):20-7. [Crossref] [PubMed]
- Nabi S. Hysteroscopic Complications. European Journal of Medical and Health Sciences. 2022;4(3). [Crossref]
- Polena V, Mergui JL, Perrot N, Poncelet C, Barranger E, Uzan S. Long-term results of hysteroscopic myomectomy in 235 patients. European journal of obstetrics, gynecology, and reproductive biology. 2007;130(2):232-7. [Crossref] [PubMed]
- Alessandro Loddo GS, Stefano Angioni. Prevention, diagnosis, and management of complications in hysteroscopic myomectomy: a literature review. 2024:1-11. [Crossref]
- Agostini A, Cravello L, Bretelle F, Shojai R, Roger V, Blanc B. Risk of uterine perforation during hysteroscopic surgery. The Journal of the American Association of Gynecologic Laparoscopists. 2002;9(3):264-7. [Crossref] [PubMed]
- Aydeniz B, Gruber IV, Schauf B, Kurek R, Meyer A, Wallwiener D. A multicenter survey of complications associated with 21,676 operative hysteroscopies. European journal of obstetrics, gynecology, and reproductive biology. 2002;104(2):160-4. [Crossref] [PubMed]
- Chapron C, Fauconnier A, Goffinet F, Breart G.,Dubuisson J.B. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod. 2002 May;17(5):1334-42. [Crossref] [PubMed]
- Corson SL, Brooks PG, Serden SP, eBatzer F.R.,Gocial B. Effects of vasopressin administration during hysteroscopic surgery. J Reprod Med 1994; 39:419. [PubMed]
- Phillips DR, Nathanson HG, Milim SJ, Haselkorn J.S., Khapra A.,Ross P.L. The effect of dilute vasopressin solution on blood loss during operative hysteroscopy: a randomized controlled trial. Obstet Gynecol 1996; 88:761. [Crossref] [PubMed]
- Touboul C, Fernandez H, Deffieux X,Berry R.,Frydman R., Gervaise A. Uterine synechiae after bipolar hysteroscopic resection of submucosal myomas in patients with infertility. Fertil Steril 2009; 92:1690. [Crossref] [PubMed]