Middle East Fertility Society Journal (2010) 15, 110–114
Middle East Fertility Society
Middle East Fertility Society Journal www.mefsjournal.com www.sciencedirect.com
Bottom-up technique for laparoscopic assisted myomectomy: A new technical approach Magdy Amin a, Kenichino Ikuma b, Ahmed Y. Rezk a, Rebecca Flyckt c, Mohamed A. Bedaiwy c,d,* a
Department of Obstetrics and Gynecology, Sohag University, Sohag Faculty of Medicine, Egypt Department of Obstetrics and Gynecology, Takarazuka City Hospital, Hyogo, Japan c Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA d Department of Obstetrics and Gynecology, Assuit University, Egypt b
Received 30 August 2009; accepted 26 December 2009 Available online 11 June 2010
KEYWORDS Laparoscopic surgery; Myomectomy
Abstract Objective: To evaluate the efﬁcacy of a new instrument and a new surgical technique for laparoscopic assisted myomectomy. Design: Prospective controlled clinical study. Setting: Takarazuka City Hospital, Japan. Subjects: Women (78) who underwent laparoscopic assisted myomectomy. Results: During the study period all cases were successfully managed using the new technique. No complications occurred. The mean operating time was 85.5 ± 39 min. The mean myoma weight was 312 ± 118.2 g. The mean amount of blood loss was 89.3 ± 28.1 ml. The mean amount of CO2 used throughout the procedure was 12 ± 5.3 L. The mean duration of the hospital stay was 1 ± 0.4 day. Long term follow-up showed that 66.6% of the infertile cases achieved pregnancy, improvement of menorrhagia was achieved in 76.4% of patients and remission of pelvic pain was achieved in 57.1% of patients.
* Corresponding author at: Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, MAC 5034, Cleveland, OH 44106, USA. Tel.: +1 216 844 8551; fax: +1 216 844 3348. E-mail address: bedaiwy[email protected]
(M.A. Bedaiwy). 1110-5690 Ó 2010 Middle East Fertility Society. Production and Hosting by Elsevier B.V. All rights reserved. Peer-review under responsibility of Middle East Fertility Society. doi:10.1016/j.mefs.2010.04.001
Production and hosting by Elsevier
New technique of laparoscopic assisted myomectomy
Conclusion: The bottom-up technique of laparoscopic assisted myomectomy using Lap Disc Mini is safe, effective and easy to use for laparoscopic management of uterine myoma. Ó 2010 Middle East Fertility Society. Production and Hosting by Elsevier B.V. All rights reserved.
1. Introduction Uterine myomas are the most common tumors of the female genital tract with an average incidence of 20–50% in women of reproductive age (1). Since the ﬁrst report of myomectomy, laparotomy has been the surgical treatment of choice for uterine myomas (2). The feasibility and safety of laparoscopic myomectomy (LM) has been conﬁrmed over the last two decades (3). However, LM is still the subject of considerable debate due to technical difﬁculty, prolonged time under anesthesia, increased blood loss, difﬁculties achieving perfect suturing to obtain a good quality scar and, ﬁnally, high risk of conversion to laparotomy (4). Laparoscopic assisted myomectomy (LAM) is advocated as a technique that may lessen the concerns regarding laparoscopic myomectomy while preserving the beneﬁts of laparoscopic surgery. As with LM, the size and position of the myoma are still the limiting factors for this technique. Combining the use of the Lap Disk Mini device and the bottom-up technique for LAM is a new surgical approach introduced by to maximize the beneﬁts of laparoscopic surgery while ensuring perfect hemostasis and sound closure of the myoma bed.
placed in the lithotomy and deep trendelenburg positions and the bladder was catheterized. A midline abdominal incision of about 2 cm width was made suprapubically, about 5 cm above the pubic tubercle and the Lap Disk Mini was introduced (Hakko Medical Co., Ltd., Japan) (Fig. 1). The laparoscope was then inserted through the iris portion of the Lap Disk Mini using a 10–12 mm trocar after adequate pneumoperitoneum was reached (Fig. 2). A second 10–12 mm supraumbilical trocar was introduced under direct visualization. The position of the laparoscope was then put through the supraumbilical port to look at the top portion of the uterus (ensuring that no injury occured during insertion. The diagnostic part of the procedure consisted primarily of a close inspection of pelvic and abdominal organs. Using forceps manipulation, the number, location, and size of the myomas were carefully
2. Materials and methods 2.1. Patient selection The study was carried out in the Department of Obstetrics and Gynecology, Takaruzua City Hospital, Japan. From January 2003 to November 2006, 78 women who had uterine myoma requiring surgical management were recruited for the study. Informed consent was obtained from all study participants. The inclusion criteria were age 18–45 years and the presence of at least one symptomatic myoma > 3 cm, a number of myoma equal or not more than three myomas with diameter