The menstrual cycle and blood loss during laparoscopic myomectomy.

INTRODUCTION: Operative morbidity of laparoscopic myomectomy largely relates to the potential for intraoperative blood loss. We sought to determine whether blood loss varies according to the menstrual cycle. MATERIAL AND METHODS: A retrospective study of 268 women who underwent a laparoscopic myomectomy from 2007 to 2012. Patients were categorized into five menstrual groups: follicular phase, luteal phase, oligomenorrheic or amenorrheic on hormonal therapy, postmenopausal or other. Patient and procedure characteristics were compared for the follicular phase group, luteal phase group, and hormonal therapy group. The estimated blood loss was compared across the five groups using a regression model. RESULTS: A total of 268 women underwent a laparoscopic myomectomy: 108 (40.3%) were in the follicular phase, 92 (34.3%) were in the luteal phase, 44 (16.4%) were on hormonal therapy, nine (3.4%) were postmenopausal, and 15 (5.6%) could not be classified. Baseline patient characteristics were similar between the groups with the exception of endometriosis. Geometric mean estimated blood loss was 91.9 mL in the follicular phase group, 108.7 mL in the luteal phase group, 114.1 mL in the hormonal therapy group, and 39.8 mL in the postmenopausal group. There was no significant difference in the geometric mean estimated blood loss when comparing the follilcuar phase, luteal phase, and hormonal phase groups (p = 0.41). Upon adjusted multivariable analysis of all five menstrual groups, there was also no difference in estimated blood loss. CONCLUSIONS: Intraoperative blood loss during laparoscopic myomectomy does not vary significantly with the phase of the menstrual cycle.

Barbed versus standard suture: a randomized trial for laparoscopic vaginal cuff closure.

STUDY OBJECTIVE: To compare closure times, cuff healing, and postoperative dyspareunia between barbed and traditional sutures during laparoscopic total hysterectomy. DESIGN: A randomized clinical trial (Canadian Task Force classification I). SETTING: A university hospital. PATIENTS: Sixty-three women undergoing total laparoscopic hysterectomy. INTERVENTIONS: Total laparoscopic hysterectomy was performed using standard techniques. The vaginal cuff closure method was randomized to barbed suture (Quill; Angiotech Pharmaceuticals, Inc., Vancouver, Canada) or standard suture (Vicryl; Ethicon Inc., Somerville, NJ). The time required for cuff closure was documented. Patients were examined postoperatively to assess cuff healing, and a standardized sexual function questionnaire was administered preoperatively and at 3 months postoperatively. MEASUREMENTS AND MAIN RESULTS: The mean vaginal cuff closure time was 10.4 minutes versus 9.6 minutes in the barbed versus standard suture group (p = .51). Cuff healing appeared similar between the 2 groups. Rates of dyspareunia, partner dyspareunia, and sexual function were similar in both groups at 3 months postoperatively. Vaginal cuff closure times were significantly faster among attendings compared with residents/fellows (7.1 vs. 12.8 minutes, respectively; p < .0001). The study was designed to have a statistical power of 80% to detect a difference of 5 minutes in cuff closure time between the 2 groups (α level of 0.05). CONCLUSION: Laparoscopic vaginal cuff closure times are similar when using barbed sutures and braided sutures.