scholarly journals Robotic Myomectomy: Until Achieving Reproductive Success, Step by Step

2021 ◽  
Author(s):  
Radamés Rivas López
Keyword(s):  
Robotic Surgery ◽  
Uterine Fibroids ◽  
Cost Benefit ◽  
Reproductive Age ◽  
Daily Activities ◽  
Benign Tumors ◽  
Surgical Team ◽  
Conventional Laparoscopic ◽  
Robotic Myomectomy ◽  
Hospital Institution

Surgeons who practice robotic surgery in benign gynecological conditions agree that in some cases, blood loss and transfusions are reduced, the time of hospital stay and of reintegration to daily activities is less, although commonly in the first cases of each surgeon surgical time may be longer than laparoscopic surgery depending on the learning curve of each. As in any other surgical technique, it is important that the surgeon is trained and certified in accordance with the guidelines that each hospital institution indicates for the practice of robotic surgery and is constantly updated through the tools provided by robotic surgery to ensure the correct use of this technology and always maintain the skill looking for the safety of the patient at all times. Uterine fibroids, are the most common benign tumors that appear in women of reproductive age. Depending on their location, number and size, the symptoms they produce vary in frequency and severity. Robotic myomectomy has shown that with a surgical team that operates frequently, it is superior to conventional laparoscopic myomectomy, even in the area of ​​cost/benefit. Robotic myomectomy is an accessible, efficient and flattering pathway for patients with fibroids who want a pregnancy.

Increased expression of neurogenic factors in uterine fibroids

2019 ◽  
Author(s):  
Alice Luddi ◽  
Camilla Marrocco ◽  
Laura Governini ◽  
Bianca Semplici ◽  
Valentina Pavone ◽  
...  
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
In Vivo Studies ◽  
Pcr Analysis ◽  
Benign Tumors ◽  
Endometrial Stromal Cells ◽  
Eutopic Endometrium ◽  
Qrt Pcr ◽  
Fertility Sparing

Abstract STUDY QUESTION Are selective markers for the neuronal differentiation such as microtubule-associated protein 2 (MAP-2) and synaptophysin (SYP) as well as the nerve growth factor (NGF) expressed by fibroids, myometrium and eutopic endometrium? SUMMARY ANSWER Neuronal markers NGF, MAP-2 and SYP are highly expressed in fibroids compared with matched myometrium, and this neurogenic pathway is upregulated by tumor necrosis factor (TNF) alpha in cultured smooth muscle cells (SMCs). WHAT IS KNOWN ALREADY Uterine fibroids or leiomyomas are the most common benign tumors, accounting for approximately one-third of hysterectomies. The present trend is to improve the medical treatment avoiding surgery, also for fertility sparing; hence, the pathogenic mechanisms are investigated, aiming to develop new therapeutic strategy. STUDY DESIGN, SIZE, DURATION This laboratory-based case–control study is focused on fibroids and myometrial specimens obtained between 2015 and 2017 from 15 women of reproductive age at the proliferative phase of the menstrual cycle. Leiomyomas, matched myometrium and endometrium from each woman were analyzed. Control endometrium was obtained from women undergoing surgery for ovarian cyst (n = 15). PARTICIPANTS/MATERIALS, SETTING, METHODS qRT-PCR, western blotting and immunostaining were applied to evaluate the expression of neurogenic markers; the effects of TNF on NGF, MAP-2 and SYP expression in cultured SMCs from leiomyomas and matched myometrium were analyzed. MAIN RESULTS AND THE ROLE OF CHANCE qRT-PCR analyses using tissues from clinical patients showed that the levels of NGF, MAP-2 and SYP mRNA were significantly higher in uterine leiomyomas compared with their matched myometrium (P < 0.05), whereas only NGF was significantly increased in eutopic endometrium compared with healthy endometrium. In primary SMCs, isolated from fibroids or from the adjacent myometrium, NGF, MAP-2 and SYP mRNA expression were significantly increased by TNF treatment (P < 0.05). Finally, human endometrial stromal cells prepared from the endometrium of patients affected by uterine fibroids display higher TNF expression (P < 0.001). LIMITATIONS, REASONS FOR CAUTION qRT-PCR analysis and immunofluorescence validation are robust methods demonstrating a clear upregulation of neurogenic factors in leiomyomas, even though additional studies are needed to establish a correlation between increased neuronal gene expression and degree of pain, as well as the involvement of inflammation mediators in the development of the neurogenic unhinge. Therefore, more in vivo studies are needed to confirm the results achieved from primary cultured SMCs. WIDER IMPLICATIONS OF THE FINDINGS The increased expression of neurogenic factors in uterine fibroids and endometrium may contribute to explain the painful stimuli. Accordingly, these neurogenic pathways may represent potential therapeutic avenues to treat the fibroid-related disorders. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by research grants from the University of Siena. The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.

scholarly journals Myomectomy during cesarean section

2021 ◽  
Vol 43 (3-4) ◽  
pp. 73-80
Author(s):  
Radmila Sparić ◽  
Đina Tomašević ◽  
Mladen Anđić ◽  
Miljan Pupovac ◽  
Aleksandra Pavić ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Perioperative Complications ◽  
Uterine Fibroids ◽  
Surgical Site Infections ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Uterine Torsion ◽  
Perioperative Bleeding ◽  
Increased Risk

Myomas (fibroids, leiomyomas) are the most common benign tumors of genital organs in women of reproductive age and represent a significant problem in women's health care. The frequency of cesarean section is higher in women with uterine fibroids. Absolute indications for myomectomy during caesarean section are: fibroids that prevent hysterotomy during caesarean section, impede uterine incision suture, hamper safe fetal extraction and cause uterine torsion. Relative indications for myomectomy during caesarean section are: subserous and pedunculated fibroids, anterior uterine wall fibroids, fibroids that can cause immediate perioperative, and puerperal complications, the patient's desire, fibroids that can cause complications in subsequent pregnancies, and fibroids that can be enucleated without additional hysterotomy. Myomectomy during caesarean section is a complex surgical procedure, associated with the possibility of considerable complications, and defining their actual frequency and risk factors for their occurrence requires further research. Myomectomy during caesarean section is associated with an increased risk of perioperative bleeding. Other perioperative complications of myomectomy during cesarean section are: disseminated intravascular coagulation, paralytic ileus, surgical site infections, sepsis, postoperative febrile morbidity, increased incidence of blood transfusions, and prolonged hospitalization.

scholarly journals High levels of ca125 in a patient with large uterine fibroid.

2020 ◽  
Vol 19 (4) ◽  
pp. 167-170
Author(s):  
Konstantinos Zacharis ◽  
Konstantinos Dafopoulos
Keyword(s):  
Abdominal Mass ◽  
Female Genital Tract ◽  
Uterine Fibroids ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Caucasian Woman ◽  
Cancer Antigen 125 ◽  
Cancer Antigen ◽  
Present Case Report ◽  
Female Genital

Uterine leiomyomas, also known as uterine fibroids, are the most common benign tumors of the female genital tract and affect 60 to 80% of women at their reproductive age. Although elevated tumor markers may be measured in benign gynaecological diseases, the association of uterine fibroids with increased levels of serum cancer antigen 125 (CA125) has not been proven to date. In the present case report we present a rare case of a 21-year-old Caucasian woman attended to our outpatient department with hypermenorrhea and pelvic discomfort that was treated for an enlarged intra-abdominal mass with an abnormally high CA-12 (777.3 U/mL).

scholarly journals Is it safe to perform myomectomy in first trimester of pregnancy? The report of two cases

2021 ◽  
Vol 6 (2) ◽  
pp. 170-174
Author(s):  
Murat Celiloglu ◽  
◽  
Samican Ozmen ◽  
Sefa Kurt ◽  
Orkun Ilgen
Keyword(s):  
Uterine Fibroids ◽  
First Trimester ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Age Group ◽  
Second Trimester ◽  
Review Of The Literature ◽  
First Trimester Of Pregnancy ◽  
Reproductive Age Group

Uterine fibroids are the most common benign tumors in women in the reproductive age group. The incidence of fibroids during pregnancy varies between 1.6 and 10.7%. In 10% of these cases, fibroids lead to complications. The management in symptomatic patients is conservative, and the surgical treatment is delayed until after birth due to its risks. In the last two decades, it has been shown that myomectomy can be an alternative treatment in selected cases, especially in second-trimester pregnancies. However, the data on the success of myomectomies performed earlier in pregnancy are limited. In this case report, we present two cases who were admitted to our clinic during the first trimester of pregnancy and had complicated fibroids. The diagnosis, the follow up and the treatment are presented with the review of the literature.

scholarly journals A study of menstrual disturbance in cases of fibroid uterus

2017 ◽  
Vol 6 (6) ◽  
pp. 2494 ◽  
Author(s):  
Rajeshwari Laxman Khyade
Keyword(s):  
Negative Impact ◽  
Uterine Fibroids ◽  
Economic Cost ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Public Health Burden ◽  
Fibrotic Tissue ◽  
Menstrual Disturbance ◽  
One Year ◽  
Pain Symptoms

Background: Leiomyoma’s also called fibroids due to their abundant fibrotic tissue have a 70-80% cumulative incidence in childbearing years. Fibroids are the most common occurring benign tumors. Fibroids represent a tremendous public health burden on women and economic cost on society.Methods: It is prospective study done over a period of one year, 50 cases presenting to the obstetrics and gynecology department. Women included were in their reproductive age between 30-55 yrs. of age and had experienced menstrual bleeding complaints.Results: The prevalence of uterine fibroids ranged from 46% in age group 41-45yrs, 24% in 46-50yrs, and 11% in 36-40yrs. Women with uterine fibroids complained of menorrhagia in 78%, dysmenorrhea in 30%, metrorrhagia in 10%, polymenorrhea 22%, pain in abdomen 22%, urinary problem 8%, SCOPV 6%, primary infertile 4%, leucorrhea 12% and lump in abdomen 4%.Conclusions: Uterine fibroid is a common problem in women of reproductive age causing various bleeding and pain symptoms that can have negative impact on various aspects of women’s life.

scholarly journals Vaginal Leiomyoma: A Case Report

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Miki Shah ◽  
Rachana Saha ◽  
Niranjan KC
Keyword(s):  
Histopathological Examination ◽  
Uterine Fibroids ◽  
Management Plan ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Reproductive Age ◽  
Benign Tumors ◽  
First Case ◽  
The Right ◽  
Vaginal Leiomyoma

Leiomyomas are common benign tumors of the uterus, affecting 20-30% of women of reproductive age group. But vaginal leiomyomas remain an uncommon entity with only about 300 reported cases. The first case was described in 1733. Only a few cases have been reported in Nepal to date. Tumors are thought to arise from Mullerian smooth muscle cells in the sub-epithelium of the vagina. Vaginal leiomyomas are usually situated in the anterior vaginal wall. Here, we report a case of a 48-year old multipara who presented the outpatient department with the ultrasonographic report showing multiple uterine fibroids but was asymptomatic. A physical examination showed a mass in the right vaginal wall. Pervaginal removal of the tumor was performed and subsequent histopathology revealed a vaginal leiomyoma. Removal of the tumor by the vaginal route, wherever possible, with the subsequent histopathological examination, appears to be the optimum management plan.

scholarly journals Spontaneous Pregnancy following Treatment of Symptomatic Uterine Myomatosis with Ulipristal Acetate without Surgery

2021 ◽  
Vol 5 (3) ◽  
pp. 01-05
Author(s):  
Vicente Spinoso Cruz ◽  
Marta Colechá Morales ◽  
Ligia Gil Melgosa ◽  
Aida Revuelta Lopez
Keyword(s):  
Uterine Fibroids ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Benign Tumors ◽  
Women Of Reproductive Age ◽  
Ulipristal Acetate ◽  
Uterine Myomas ◽  
Spontaneous Pregnancy ◽  
Future Fertility ◽  
Effective Option

Uterine fibroids are the most frequent gynaecological benign tumors in women of reproductive age and can cause infertility. Their treatment may be medical, surgical or a combination of both, but they may compromise future fertility in patients in which their wish to conceive has not yet been fulfilled. In this report we present two patients with symptomatic uterine myomas and who wanted to preserve their fertility. Treatment with one or two 12-week courses of 5 mg of ulipristal acetate was prescribed. A decrease in the size of the fibroids was observed, along with adequate control of the symptoms. Spontaneous pregnancies led to two live births without significant complications. Treatment with Ulipristal Acetate may be an effective option to take into account in the management of patients with symptomatic uterine fibroids who refuse surgery or in those in which it is contraindicated and who wish to preserve their fertility.

scholarly journals Innovative Oral Treatments of Uterine Leiomyoma

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Mohamed Sabry ◽  
Ayman Al-Hendy
Keyword(s):  
Uterine Fibroids ◽  
The United States ◽  
Uterine Wall ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Medical Treatments ◽  
Major Health ◽  
Future Fertility ◽  
Medicinal Treatment

Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail.

scholarly journals Morphological characteristics of uterine fibroids among women of reproductive age

2017 ◽  
Vol 66 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Saodat M Safarova
Keyword(s):  
Histological Study ◽  
Uterine Fibroids ◽  
Receptor Expression ◽  
Reproductive Age ◽  
Benign Tumors ◽  
Image Analysis System ◽  
Proliferation Marker ◽  
Women Of Reproductive Age ◽  
Ki 67 ◽  
Apoptosis Inhibitor

The article deals with modern views on etiopathogenesis of uterine fibroids. Increased knowledge of the markers of proliferation and their study will help to predict the course of the disease and thus to develop the optimum tactics of the further treatment of the early stages. Much attention is paid to the study of markers that characterize apoptosis. By immunohistochemistry in tissue fibroids 15 patients studied protein expression Ki-67 and Bcl-2. Analyzed values of the correlation expression of the proteins according to the clinical and morphological features of the tumor. It showed a reduction in the proliferation marker Ki-67, and increased expression of apoptotic Bcl-2 inhibitor.Background. Presented by changes in the nature of proliferation and apoptotic activity in myoma nodes among women of reproductive age who underwent conservative myomectomy.The aim of the research was to study the performance of protein antibody Ki-67 proliferation and apoptosis inhibitor of Bcl-2 in women with uterine myoma.Material and methods. Surveyed 15 women with uterine fibroids who underwent conservative myomectomy. Inclusion criteria were: the reproductive age, uterine fibroids the size of which does not exceed the 12-week pregnancy. Exclusion criteria were the size of fibroids greater than 12 weeks of pregnancy, acute inflammatory diseases of the pelvic organs, severe somatic diseases, cancer of the reproductive organs. It was carried out histological and immunohistochemical study of remote myoma node. We examined by immunohistochemistry proliferation protein monoclonal antibody Ki-67 (Clone MIB-1, 1 : 150, Dako), inhibitor of apoptosis Bcl-2 (NCL-bcl-2-486). (Novocastra). Evaluation of the expression of markers studied conducted qualitative and quantitative methods in computer image analysis system “Morphology 5.0” (Video Test, Russia). Statistical processing of the results was performed using statistical analysis packages (STATGRAPHICS v. 6.0).Results. Age of women surveyed averaged 33,4 ± 4,1 years. Histological study of benign tumors of the uterus body showed the presence of degenerative changes, necrosis and inflammatory infiltration in every fourth case of the material.Conclusions. Immunogistohimichesoe study of uterine leiomyomas body revealed a significant increase in the expression of apoptosis inhibitor of Bcl-2 and reducing the proliferation marker Ki-receptor expression in all 67 tested samples, which is consistent with a histological study of the absence of mitotic activity in leiomyomas.

scholarly journals Large cervical fibroid: a rare case report

2019 ◽  
Vol 8 (8) ◽  
pp. 3414
Author(s):  
Sunanda N.
Keyword(s):  
Uterine Fibroids ◽  
Total Abdominal Hysterectomy ◽  
Large Mass ◽  
Abdominal Hysterectomy ◽  
Reproductive Age ◽  
Pelvic Tumors ◽  
Rare Case Report ◽  
Tender Mass ◽  
Restricted Mobility ◽  
Reproductive Age Group

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. 

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