Uterine fibroids, laparoscopic surgery and morcellation. Literature review

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 22-25
Author(s):  
Alexander A Seregin ◽  
Anastasiia B Nadezhdenskaya ◽  
Aleksandra V Asaturova ◽  
Dmitry L Ovodenko
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Extraction Process ◽  
Uterine Myoma ◽  
Historical Aspect ◽  
Surgical Interventions ◽  
Oncological Safety ◽  
High Level

Aim. To analyze the literature data on modern approaches to morcellation of myomatous nodes in laparoscopic surgery and to highlight this area in a historical aspect. To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation. Materials and methods. The review includes data from foreign articles published in the elibrary.ru and PubMed databases on this topic. Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them. Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.

New aspects in the treatment of uterine leiomyoma associated with endometriosis

2017 ◽  
pp. 32-35
Author(s):  
V.V. Kaminskiy ◽  
◽  
E.V. Prokopovych ◽  
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Uterine Fibroids ◽  
Progesterone Receptors ◽  
Objective Evaluation ◽  
Treatment Method ◽  
Integrated Treatment ◽  
Uterine Myoma ◽  
Ulipristal Acetate ◽  
High Level

Despite the high level of development of modern surgery and pharmacology, none of the surgical techniques (hysterectomy / myometectomy or embolization of the uterine arteries) or drug therapy is not a guarantee of the absence of a future recurrence of uterine fibroids and endometriosis. However, there are methods of effective pharmacotherapy for their manifestations. In particular, selective progesterone receptor modulators (SMPR) demonstrate high efficacy in respect of the symptoms of myoma and the size of the nodes, which allows them to be considered as a complete alternative to the surgical treatment of uterine fibroids. The objective: evaluation of the effectiveness of the use of SMPR in the treatment of combined gynecological diseases. Patients and methods. The study included materials for the observation of 40 women 20–52 years old with uterine myoma against the background of combined gynecological pathology (endometriosis, infertility), which carried out the enucleation of myomatous nodes by laparotomy, laparoscopic or transcervical access. Patients were divided into two groups. In the main group (n=20), women received SMPR – ulipristal acetate (UPA) 5 mg daily for 3 months. The UIA's bioavailability is 70%. The optimal therapeutic single dose for the analyzed pathology is 5 mg. After 3 months, the first assessment of the effectiveness of the drug with combined gynecological pathology was conducted, then 14 women were exposed to surgical treatment, and 6 of 20 patients continued conservative treatment for another 1–4 months. After the operation to prevent the recurrence of uterine fibroids and endometriosis, 8 patients continued treatment of UPA for 4 months. In the comparison group (n=20), women underwent surgical treatment at similar rates, but the SMPR was not assigned to surgery. Results. Of the studies indicate that the use of such a selective modulator of progesterone receptors, like vandalite acetate, in the treatment of uterine myomas in combination with endometriosis is safe and well tolerated, leads to rapid persistent coping of uterine bleeding, a significant decrease in the size of nodes and foci of endometriosis, and the achieved The therapeutic effect is maintained even after the abolition of therapy. Conclusion. Thus, the use of the drug ulipristal acetate in the treatment of uterine fibroate on the background of combined gynecologic pathology is highly effective and promising as an independent and integrated treatment method of this category of patients. Key words: uterine myoma, endometriosis, selective modulators of progesterone receptors, viperpatel acetate, combined oral contraceptives.

scholarly journals Current trends in the pharmacotherapy of uterine myoma, associated with heavy menstrual bleeding and anemia: review

2020 ◽  
Author(s):  
Z. V. Revazova ◽  
L. V. Adamyan ◽  
O. N. Loginova ◽  
L. M. Manukyan ◽  
K. N. Arslanyan
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Reproductive Age ◽  
Heavy Menstrual Bleeding ◽  
Menstrual Bleeding ◽  
Cochrane Library ◽  
Pharmacological Agents ◽  
Surgical Interventions ◽  
Current Trends

Aim: to summarize results of up-to-date world researches on the current trends of symptomatic myoma treatment.Materials and Мethods. A search of publications was carried out in the main international databases in Russian and English languages: PubMed/MEDLINE, The Cochrane Library, Embase, eLibrary. The analysis included studies published over the past 10 years examining the clinical efficacy and safety of various groups of pharmacological agents for the treatment of uterine myoma combined with heavy menstrual bleeding in women of reproductive age.Results. Currently, the treatment of uterine fibroids is divided into three main methods: surgical, minimally invasive organ-preserving methods, and pharmacotherapy. Until now, surgical intervention remains the main method of treatment, and, unfortunately, is often carried out in the volume of hysterectomy. However, today it is important to have a personalized approach to the management of a patient with symptomatic uterine myoma, taking into account her desire to preserve reproductive function. The development of the possibilities of drug therapy made a great contribution to the optimization of managing such patients.Conclusion. The global trend is to decrease the number of radical interventions, as well as the development and improvement of new methods of treating symptomatic uterine fibroids. Currently, pharmacotherapy of leiomyoma can significantly improve the quality of life of patients, reduce radical surgical interventions, optimize surgical treatment, and in certain situations, completely eliminate the need for surgery.

scholarly journals Surgical correction of the chronic liver purulent-septic lesions

2019 ◽  
Vol 41 part 2 (2) ◽  
pp. 12-18
Author(s):  
O. G. Kotenko ◽  
A. V. Gusev ◽  
O. O. Popov ◽  
A. V. Grinenko ◽  
M. S. Grigoryan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Chronic Liver ◽  
Study Group ◽  
Anatomical Resection ◽  
Duration Of Treatment ◽  
Surgical Interventions ◽  
Liver Abscesses ◽  
Resection Of The Liver

Purpose of the study. The purpose of the study is to improve the results of surgical treatment of patients with purulent-septic lesion of the liver substantiating the indication for resection method use. Material and methods. The work is based on a comparative analysis of the results of examination and treatment of 64 patients aged 10 to 81 years old, with chronic liver abscesses in the department of surgery and liver transplantation during the 1995–2016 periods. According to the tasks of the study patients are divided into two groups. In 30 (46,8%) patients (the study group), various types of anatomical resection of the liver with a purulent lesion were performed without its dissection during the operation; in 34 (53,2%) patients (group of comparison) they performed the disclosure, sanation, drainage of purulent cavity. The majority of patients with chronic liver abscesses treated the abscess with a puncture or drainage method under the control of ultrasound in other medical institutions of Ukraine. Results. The results of diagnosis and treatment of 64 patients for chronic liver abscesses from 1995 to 2016 are analyzed. In the study group, the patients performed anatomical resection of the liver, in the comparison group – standard surgical interventions – the disclosure and drainage of the abscess of the liver. The duration of antibiotic therapy after surgery in the comparison group is significantly higher than in the study group, respectively, 22 ± 3,4 and 5,75 ± 1,6 days; p < 0,001. Second-line antibacterial drugs after draining operations were used more often (p < 0,001) than after resection interventions, respectively, in 94,1 and 6,6% of cases. The duration of treatment of patients in the hospital after surgery in the study group was less than in the comparison group, according to 15,1 ± 0,7 and 27,3 ± 3,05 days; total 25,9 ± 1,4 and 45,7 ± 3,45 days (p < 0,001). After drainage operations, drainages from the abdominal cavity were removed later than after resection interventions, respectively, 17,1 ± 2,8 and 6,35 ± 1,1 days (p < 0,001), through. Conclusion. Resection for chronic purulentseptic lesions of the liver is the priority methods of surgical treatment. The analysis of the obtained results allows us to conclude that resection technologies contribute to the rapid normalization of physical and social rehabilitation of patients with septic liver damage. Keywords: liver abscess, liver resection, chronic, purulent-septic.

scholarly journals RESULTS OF SURGICAL TREATMENT OF NON-PARASITIC SPLENIC CYSTS IN CHILDREN

2018 ◽  
Vol 22 (1) ◽  
pp. 32-35
Author(s):  
A. V. Myzin ◽  
Vasily G. Kuleshov ◽  
A. E. Stepanov ◽  
N. V. Gerasimova ◽  
K. Yu. Ashmanov
Keyword(s):  
Surgical Treatment ◽  
High Efficiency ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Long Term Results ◽  
Surgical Interventions ◽  
Results Of Treatment ◽  
Splenic Cysts ◽  
Good Cosmetic

Introduction. Currently, there are different views on the treatment of non-parasitic spleen cysts in children. The choice of method of treatment is under discussion. The aim of our study was to evaluate and analyze the immediate and long-term results of surgical interventions performed on nonparasitic spleen cysts in children. Material and methods. There are presented results of surgical treatment of the 21 patient, who was on treatment at the Department of Abdominal Surgery of the Russian Children Clinical Hospital over the period from 2013 to 2016. Patients were examined by means of ultrasound of the abdominal cavity, CT, MRI. All patients have been operated. 22 surgical interventions were performed by using laparoscopic access, out of which 2 partial resections of the spleen, 1 splenectomy, 19 fenestrations of spleen cysts.Results. During the course of the operation and in the immediate postoperative period there were no complications. Patients were observed for the period of from 1 year to 3 years. Good results of treatment were obtained in 20 (95.2%) children. In a long-term period a relapse occurred in the one patient one year after the operation. The patient was reoperated, splenectomy was performed. Conclusion. The surgical treatment of spleen cysts is the basic one. It is indicated for cysts sized larger than 5 cm and cysts with clinical symptoms. Minimally invasive interventions in children are optimal because of their low traumatism and good cosmetic effect. Our study showed a high efficiency of laparoscopic operations in children suffered from non-parasitic spleen cysts with good long-term results.

scholarly journals Experience of the use of anti-adhesive barrier based on sodium hyaluronate and carboxymethylcellulose in gynecological surgery

2019 ◽  
pp. 149-153
Author(s):  
A. S. Molotkov ◽  
E. N. Popov ◽  
A. O. Ivanova ◽  
E. V. Kazantseva
Keyword(s):  
Postoperative Period ◽  
Abdominal Cavity ◽  
Uterine Fibroids ◽  
Sodium Hyaluronate ◽  
Uterine Cavity ◽  
Early Postoperative Period ◽  
Gynecological Surgery ◽  
Surgical Interventions ◽  
And Control

The article presents our experience in the use of anti-adhesive barrier based on hyaluronic acid and carboxymethylcellulose in gynecological surgery. The study included 63 patients who underwent removal of polyps, uterine fibroids, intrauterine synechiae, removal of ovarian cysts. At the end of operations an anti-adhesive gel was introduced into the uterine cavity and into the abdominal cavity to prevent adhesions. Efficacy and safety were assessed in the early postoperative period and with a further sixmonth follow-up of patients. It is noted that the introduction of the gel does not lead to the development of hyperthermic reactions, and in the postoperative period in patients there is no increase in the level of leukocytes (6.3 ± 0.2 x 109/L before the operation and 5.8 ± 0.5 x 109/L in postoperative period). In 89.7% of patients after surgical interventions, normalization of the menstrual cycle was noted, in 23% of patients with infertility, pregnancy was noted. When carrying out ultrasound of the pelvic organs and control hysteroscopy (in 7 cases), no evidence of the occurrence of adhesions was obtained.

Place and significance of reconstructive surgical interventions in patients with high corrosive strictures of the bile ducts

2020 ◽  
pp. 3-14
Author(s):  
Sergei Trifonov ◽  
Yuri Kovalenko ◽  
Aleksey Varava ◽  
Vladimir Vishnevsky
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Bile Ducts ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Treatment Results ◽  
External Drainage ◽  
Surgical Interventions ◽  
High Level ◽  
Stricture Recurrence ◽  
Transhepatic Biliary Drainage

The most technically difficult for reconstructive interventions on the bile ducts with a high level of postoperative complications and recurrences are strictures of “-1”, “-2” and “-3” types according to E. Halperin (type E3 - E5 according to Bismuth-Strasberg). From 2012 to 2018 the A.V. Vishnevsky Institute of Surgery treated 96 patients with this pathology. The best treatment results were observed in patients with preserved confluence – 92% of successful interventions. An independent risk of stricture recurrence is previous external drainage of the bile ducts after injury, a high level of stricture (“-1”, “-2” and “-3” types according to E. Halperin). Surgical treatment of corrosive strictures is the method of choice when there is the ineffectiveness of endoscopic and percutaneous transhepatic biliary drainage, although it is associated with a high risk of postoperative complications.

SOCIAL AND ECONOMIC EFFECTIVENESS OF THE INTRODUCTION OF COMBINED SINGLE-STAGE SURGICAL INTERVENTIONS

2021 ◽  
Vol 1 (15) ◽  
pp. 66-72
Author(s):  
N.Y. Kondratyuk ◽  
O. O. Litvak
Keyword(s):  
Surgical Treatment ◽  
Economic Effect ◽  
Economic Cost ◽  
Economic Feasibility ◽  
Single Stage ◽  
Uterine Myoma ◽  
Surgical Interventions ◽  
One Stage ◽  
Number Of Patients ◽  
Study Results

In gynecological practice, due attention is paid to increasing the efficiency of institutions and organizations for surgical treatment of patients, in particular, rational use of hospital beds, reducing the economic cost of operations and rehabilitation of patients, reducing the time of hospitalization and incapacity for work, besides the above, the expediency of expanding the scope of surgical intervention is also increasing. The aim of the study is to prove the economic feasibility of combined single-stage surgical interventions in gynecological patients.Materials and Methods. The study was based on a retrospective analysis of the immediate results of surgical treatment of 50 women with uterine myoma operated on using combined (hystero-, laparo-) access and intracorporeal continuous suturing of the node bed (an innovative proposal) in the Scientific and Research Center SIS RPCPCM SAD. The results were in comparison with the same number of patients who underwent isolated operations of laparoscopy and hysteroscopy. Study results and discussion. As a result of the calculations, it was established that the total economic effect of the treatment using a combined one-stage operation was 8765.37 hryvnias per patient. This confirms the economic feasibility of this type of surgery compared to the two isolated ones. Conclusions. The results of the study indicate the economic feasibility of performing a combined one-stage hysteroscopy and laparoscopy for uterine myoma.

scholarly journals Reproductive outcomes following surgical removal of uterine fibroids

2019 ◽  
pp. 110-118
Author(s):  
A. E. Mitichkin ◽  
Yu. E. Dobrokhotova ◽  
N. Yu. Ivannikov ◽  
V. I. Dimitrova ◽  
O. A. Slyusareva ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Drug Withdrawal ◽  
Uterine Fibroids ◽  
Reproductive Function ◽  
Uterine Myoma ◽  
Surgical Removal ◽  
Birth Canal ◽  
Uterine Arteries ◽  
Natural Birth ◽  
Prospective Comparative Study

The cohort prospective comparative study investigated the efficacy of mifepristone use in patients after surgical treatment of uterine myoma. It was shown that the use of mifepristone at a dose of 50 mg/day in a continuous mode for 3 months after surgical treatment for proliferating uterine myoma led to the absence of recurrences of the disease for 2 years after the drug withdrawal. The use of mifepristone after embolization of uterine arteries allowed to significantly reduce the size of the node by 25% during 12 months and by 50% (p<0.05) after 24 months. Complex treatment of uterine myoma, including myomectomy and drug therapy with mifepristone, allowed to realize reproductive function in 46% of patients, and delivery through the natural birth canal occurred in 24% of patients.

Modern non-drug technologies of rehabilitation for patients after surgical treatment of uterine myoma

2020 ◽  
pp. 78-88
Author(s):  
Ekaterina Zhumanova ◽  
Elizaveta Koneva ◽  
Tatyana Shapovalenko ◽  
Konstantin Lyadov ◽  
Natalia Korchazhkina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Uterine Fibroids ◽  
Review Article ◽  
Uterine Myoma

The review article presents data on scientific studies carried out in recent decades on the use of modern non-drug technologies in the rehabilitation of patients after surgical treatment of uterine fibroids.

scholarly journals Application of endovideosurgery in the treatment of ventral hernias after gunshot wounds of the abdomen

2018 ◽  
Vol 22 (3) ◽  
pp. 471-473
Author(s):  
M.A. Kashtalian ◽  
O. S. Herasymenko ◽  
R.V. Yenin ◽  
A.A. Kvasnevskiy
Keyword(s):  
Surgical Treatment ◽  
Abdominal Cavity ◽  
Gunshot Wounds ◽  
Surgical Interventions ◽  
The Third ◽  
The Past ◽  
Abdominal Organs ◽  
Laparoscopic Techniques ◽  
Ventral Hernias ◽  
Abdominal Compartment

Gunshot wounds of the abdomen are often accompanied by a significant destruction of the abdominal cavity with the development of peritonitis, and in the future — various complications (failure of anastomoses, abscess formation, repeated bleeding, etc.), which requires repeated surgical interventions, and as a consequence — the formation of postoperative ventral hernias. The aim of the study is to improve the results of surgical treatment of ventral hernias after gunshot wounds of the abdomen due to the use of laparoscopic techniques. The analysis of treatment of 21 patients with postoperative ventral hernias formed as a result of operations concerning gunshot wounds of the abdomen was carried out. 14 wounded suffered one operation on the abdominal organs in the past (66.7%), 5 — two operations (23.8%), 1 — three operations (4.8%), 1 — five operations (4.8%). The dimensions of the hernial gates and the risk of recurrence were determined according to the SWE classification: W1 — 9 patients (42.9%), W2 — 8 (38.1%), W3 — (9.5%), W4 — 2 (9.5% ). The third patients underwent laparoscopic allogernioplasty according to the IROM technique with a Teflon allograft, which was fixed in 2 cases with the help of a herniostepler, in the 1st — with transdermal separate seams with Teflon filament. Complications after laparoscopic operations were not. The use of laparoscopic techniques can significantly reduce bed-day, avoid the development of abdominal compartment syndrome, previously to activate the patient. Laparoscopic allogernioplasty according to the method of IPOM by the Teflon graft is considered to be the operation of choice.

Sign in / Sign up

Export Citation Format

Share Document