Minimally Invasive Approaches to the Surgical Management of Fibroids

2017 ◽  
Vol 35 (06) ◽  
pp. 533-548 ◽  
Author(s):  
Harold Wu ◽  
Karen Wang
Keyword(s):  
Minimally Invasive ◽  
Surgical Management ◽  
Reproductive Tract ◽  
Fluid Management ◽  
Benign Neoplasm ◽  
Abnormal Uterine Bleeding ◽  
Female Reproductive Tract ◽  
Treatment Modalities ◽  
Preoperative Treatment ◽  
Management Interventions

AbstractUterine fibroids, as the most common benign neoplasm of the female reproductive tract, can significantly impact a woman's quality of life through abnormal uterine bleeding, infertility, and bulk symptoms. When medical therapy for symptomatic fibroids fails, surgery is the recommended treatment. While a hysterectomy through laparotomy was historically the first-line surgical approach for fibroids, multiple minimally invasive and uterine-sparing techniques are now available. An evidence-based literature review of the following minimally invasive approaches is detailed in this article: hysteroscopic myomectomy, laparoscopic and robotically assisted myomectomy, laparoscopic and robotically assisted hysterectomy, and ultrasound-guided radiofrequency ablation. For each approach, this review discusses the indications, patient selection, adjunct preoperative treatment modalities, instrumentation, techniques, and pertinent intraoperative considerations such as fluid management, interventions to reduce blood loss, antiadhesion barriers, and tissue extraction. Perioperative benefits, long-term outcomes including recurrence and fertility, and comparisons of outcomes among the various approaches are outlined as well. With continued technological advancements and surgical innovations, minimally invasive techniques will become the mainstay of surgical management for symptomatic fibroids to provide high-quality patient-centered care.

COMPARATIVE STUDY OF ENDOMETRIAL CYTOLOGY AND ENDOMETRIAL BIOPSY IN PERI MENOPAUSAL WOMEN

2021 ◽  
pp. 42-43
Author(s):  
Vasudha Rani ◽  
Punam Kumari ◽  
Asha Jha
Keyword(s):  
Endometrial Cancer ◽  
Minimally Invasive ◽  
Endometrial Hyperplasia ◽  
Abnormal Uterine Bleeding ◽  
Endometrial Biopsy ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Focal Lesion ◽  
Diagnostic Strategy ◽  
Rule Out

Abnormal Uterine Bleeding (AUB) is one of the most common health problems encountered by women. It affects about 20% women of reproductive age, and accounts for almost two thirds of all hysterectomies. Gynaecologists are often unable to identify the cause of abnormal bleeding even after a thorough history and physical examination. Diagnostic evaluations and treatment modalities have been evolving over time. The onus in AUB management is to exclude complex endometrial hyperplasia and endometrial cancer. From D and C + EUA under general anaesthesia the shift to more accurate procedures like hysteroscopy and vision directed biopsy was welcome. But the current minimally invasive procedures like sonohysterography, ofce vacuum aspiration (Pipette) and the use of ofce hysteroscopy have revolutionized the management of AUB. We have tried to review the current literature and guidelines for evaluation of endometrium with the twin goals of nding an accurate reason causing the AUB and to rule out endometrial cancer or a potential for the cancer in future. We have also attempted to compare the current procedures and their present perspective vis-à-vis each other. Histological assessment is the nal word, but obtaining a sample for histology makes it more accurate, and we have reviewed these techniques to enhance accuracy in diagnosis. Hysteroscopy and directed biopsy is the 'gold standard' approach for most accurate evaluation of endometrium to rule out focal endometrial Carcinoma. Blind endometrial biopsies should no longer be performed as the sole diagnostic strategy in perimenopausal as well as in postmenopausal women with AUB. Asingle-stop approach, especially in high risk women (Obesity, diabetes, family history of endometrial, ovarian or breast cancer) as well as in women with endometrial hyperplasia of combining the ofce hysteroscopy, directed biopsy in presence of a focal lesion, and vacuum sampling of endometrium in normal looking endometrium, all without anesthesia is the most minimally invasive and yet accurate approach in current practice.

scholarly journals Sonographic Presentation of Endometrial Carcinoma Stage I: A Case Study

2018 ◽  
Vol 34 (4) ◽  
pp. 292-297
Author(s):  
Nathalie Castaneda
Keyword(s):  
Endometrial Carcinoma ◽  
Reproductive Tract ◽  
Premenopausal Women ◽  
Abnormal Uterine Bleeding ◽  
Figo Stage ◽  
Endometrial Biopsy ◽  
Female Reproductive Tract ◽  
Endometrioid Adenocarcinoma ◽  
Gynecology And Obstetrics ◽  
Conclusive Diagnosis

Endometrial carcinoma is the most commonly diagnosed malignancy in the female reproductive tract, mainly affecting women in their postmenopausal years. Although rare, it can also present in premenopausal women. The most common clinical presentation is episodes of abnormal uterine bleeding. Magnetic resonance imaging (MRI), computed tomography (CT), and sonography are imaging modalities used to detect endometrial carcinoma. However, a conclusive diagnosis is made through endometrial biopsy. A case is reported of endometrial distension with endometrial carcinoma and cervical stenosis listed as differentials and originally detected through CT. Sonographic assessment showed an irregular thickened endometrium and an endometrial cavity containing fluid with low-level echoes and areas of polypoid mass-like tissue. Based on these findings, the patient underwent an endometrial biopsy that provided confirmation of endometrioid adenocarcinoma (International Federation of Gynecology and Obstetrics [FIGO] Stage 1).

scholarly journals Myomectomy Revisited: Experiences in a Teaching Hospital

2016 ◽  
Vol 54 (202) ◽  
pp. 79-81
Author(s):  
Shanti Subedi ◽  
Manisha Chhetry ◽  
Sabina Lamichhane
Keyword(s):  
Teaching Hospital ◽  
Reproductive Tract ◽  
College Teaching ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Female Reproductive Tract ◽  
Benign Tumors ◽  
Presenting Symptoms ◽  
Uterine Myomas ◽  
Common Location

Introduction: Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital.Methods: A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016.Results: Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tourniquet was used. None of the patients had significant post-operative morbidity except fever in the first 24 hours.Conclusions: Abdominal myomectomy is a safe and effective procedure for uterine myomas for infertile women in the past but it should be offered to those desiring for uterine preservation irrespective of age and reproductive status. Keywords: abnormal uterine bleeding; degeneration; myomectomy. | PubMed

Case 10.7

2014 ◽  
pp. 490-490
Author(s):  
Christine U. Lee ◽  
James F. Glockner
Keyword(s):  
Reproductive Tract ◽  
Normal Development ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Female Reproductive Tract ◽  
Fallopian Tubes ◽  
Class Iii ◽  
Class V ◽  
Unicornuate Uterus ◽  
Mullerian Ducts

45-year-old woman with abnormal uterine bleeding Axial oblique FSE T2-weighted images (Figure 10.7.1) show a banana-shaped uterus with a single horn. Note also small nabothian cysts in the cervix. Unicornuate uterus Müllerian duct anomalies are not common, but their importance lies in the fact that some of them represent treatable causes of infertility. The female reproductive tract develops primarily from the paired müllerian ducts, which form the fallopian tubes, uterus, cervix, and upper two-thirds of the vagina. Normal development requires completion of organogenesis, fusion, and septal resorption. Failure of organogenesis leads to class I and class II anomalies (agenesis/hypoplasia and unicornuate uterus). Abnormalities of fusion result in bicornuate and didelphic configurations (class III and class VI). Incomplete or absent septal resorption results in a septate (class V) or arcuate (class VI) uterus....

Effect of Contraceptive Steroids on the Endometrium of Guinea Pig: SEM study

1977 ◽  
Vol 35 ◽  
pp. 668-669
Author(s):  
Mai M. Said ◽  
Ramesh K. Nayak ◽  
Randall E. McCoy
Keyword(s):  
Guinea Pig ◽  
Reproductive Tract ◽  
Three Dimensional ◽  
Female Reproductive Tract ◽  
Human Female ◽  
Surface Ultrastructure ◽  
Transmission Electron ◽  
Sem Study ◽  
Uterine Mucosa ◽  
Group 1

Burgos and Wislocki described changes in the mucosa of the guinea pig uterus, cervix and vagina during the estrous cycle investigated by transmission electron microscopy. More recently, Moghissi and Reame reported the effects of progestational agents on the human female reproductive tract. They found drooping and shortening of cilia in norgestrel and norethindrone- treated endometria. To the best of our knowledge, no studies concerning the effects of mestranol and norethindrone given concurrently on the three-dimensional surface features on the uterine mucosa of the guinea pig have been reported. The purpose of this study was to determine the effect of mestranol and norethindrone on surface ultrastructure of guinea pig uterus by SEM.Seventy eight animals were used in this study. They were allocated into two groups. Group 1 (20 animals) was injected intramuscularly 0.1 ml vegetable oil and served as controls.

Surface ultrastructure of danazol treated rat endometrium: A SEM study

1983 ◽  
Vol 41 ◽  
pp. 556-557
Author(s):  
R.P. Apkarian ◽  
J.S. Sanfilippo
Keyword(s):  
Cross Sections ◽  
Reproductive Tract ◽  
Preliminary Investigation ◽  
Breast Disease ◽  
Distal Segment ◽  
Uterine Horn ◽  
Female Reproductive Tract ◽  
Ultrastructural Changes ◽  
Cycle Phase ◽  
Sprague Dawley

The synthetic androgen danazol, is an isoxazol derivative of ethisterone. It is utilized in the treatment of endometriosis, fibrocystic breast disease, and has a potential use as a contraceptive. A study was designed to evaluate the ultrastructural changes associated with danazol therapy in a rat model. The preliminary investigation of the distal segment of the rat uterine horn was undertaken as part of a larger study intended to elucidate the effects of danazol on the female reproductive tract.Cross-sections (2-3 mm in length) of the distal segment of the uterine horn from sixteen Sprague-Dawley rats were prepared for SEM. Ten rats in estrus served as controls and six danazol treated rats were noted to have alterations of the estrus cycle i.e. a lag in cycle phase or noncycling patterns. Specimens were fixed in 3% glutaraldehyde in 0.05M phosphate buffer containing CaCl2 at pH 7.0-7.4 and chilled to 4°C. After a brief wash in distilled water, specimens were passed through a graded series of ethanol, critical point dryed in CO2 from absolute ethanol, and coated with 6nm Au. Observations were made with an IS1-40 SEM operated at 15kV.

The application of electron microscopy to diagnosis in gynecologic neoplasms and tumor-like conditions

1984 ◽  
Vol 42 ◽  
pp. 102-105
Author(s):  
Lawrence M. Roth
Keyword(s):  
Electron Microscopy ◽  
Reproductive Tract ◽  
Malignant Tumors ◽  
Frozen Section ◽  
Cost Effective ◽  
Female Reproductive Tract ◽  
Ultrastructural Examination ◽  
Specific Diagnosis ◽  
Potential Value ◽  
Gynecologic Neoplasms

The female reproductive tract may be the site of a wide variety of benign and malignant tumors, as well as non-neoplastic tumor-like conditions, most of which can be diagnosed by light microscopic examination including special stains and more recently immunoperoxidase techniques. Nevertheless there are situations where ultrastructural examination can contribute substantially to an accurate and specific diagnosis. It is my opinion that electron microscopy can be of greatest benefit and is most cost effective when applied in conjunction with other methodologies. Thus, I have developed an approach which has proved useful for me and may have benefit for others. In cases where it is deemed of potential value, glutaraldehyde-fixed material is obtained at the time of frozen section or otherwise at operation. Coordination with the gynecologic oncologist is required in the latter situation. This material is processed and blocked and is available if a future need arises.

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