Surgical impact of bilateral transient occlusion of uterine and utero-ovarian arteries during laparoscopic myomectomy.

The objective of this article is to compare the amount of intraoperative blood loss during laparoscopic myomectomy when performing bilateral transient clamping of the uterine and utero-ovarian arteries versus no intervention. It´s a randomized controlled prospective study carried out in the Department of Obstetrics and Gynecology Ramón y Cajal University Hospital and HM Montepríncipe-Sanchinarro University Hospital, Madrid, Spain, in women with fibroid uterus undergoing laparoscopic myomectomy. Eighty women diagnosed with symptomatic fibroid uterus were randomly assigned to undergo laparoscopic myomectomy without additional intervention (Group A) or temporary clamping of bilateral uterine and utero-ovarian arteries prior to laparoscopic myomectomy (Group B). Estimated blood loss, operating time, length of hospital stay, and postoperative hemoglobin values were compared in both groups. The number of fibroids removed was similar in both groups (p = 0.77). Estimated blood loss was lower in the group of patients with prior occlusion of uterine arteries (p = 0.025) without increasing operating time (p = 0.17) nor length of stay (p = 0.17). No patient had either intra or postoperative complications. Only two patients (2.5%) required blood transfusion after surgery. We conclude that temporary clamping of bilateral uterine arteries prior to laparoscopic myomectomy is a safe intervention that reduces blood loss without increasing operative time.

Outcomes after Hysteroscopic Treatment of Symptomatic Isthmoceles in Patients with Abnormal Uterine Bleeding and Pelvic Pain: A Prospective Case Series.

BACKGROUND: Isthmoceles are described as complications associated with caesarean section (CS). Only symptomatic isthmoceles should be treated. The main symptoms are abnormal uterine bleeding (AUB) in the absence of any other causes, pelvic pain and secondary infertility. There are several techniques described for the correction of isthmoceles. Isthmoplasty can be performed by hysteroscopy, laparoscopy or vaginal surgery. The aim of this study was to assess the effectiveness of hysteroscopic surgical treatment of isthmoceles in women with associated symptoms such as pelvic pain and AUB. MATERIALS AND METHODS: A prospective case series study was performed; this study included all women with AUB, pelvic pain and ultrasonographic (US) diagnosis of isthmocele, who had undergone hysteroscopic correction between June 2014 and December 2017 in our Hospital. RESULTS: Thirty eight women underwent surgical hysteroscopy for correction of symptomatic isthmoceles. All patients presented AUB, 42.1% experienced pelvic pain and 28.9% had secondary infertility. US evaluation of isthmoceles was performed using 2D ultrasound. The residual myometrial thickness (RMT) above the isthmocele was measured in women who expected future pregnancy; if it was <2.5 mm the patient was not included in the study because the correction was performed laparoscopically. Follow-up was performed one and two months after the surgery. In all cases, pelvic pain was resolved one month after the surgery. AUB disappeared within the first month in 87.5% of patients and in the second month in 96.8% of subjects; however, one patient needed further surgery to alleviate her symptoms. Secondary infertility was assessed one year after surgical isthmoplasty. Seven women completed the first year of follow up, and three of them (42.8%) reported pregnancy after treatment between six and eight months after the surgery. CONCLUSION: Hysteroscopic correction of symptomatic isthmoceles may constitute a safe and effective technique for patients who present AUB and pelvic pain.

A uterine tumor resembling ovarian sex cord tumor associated with tamoxifen treatment: a case report and literature review.

Uterine tumors resembling ovarian sex cord tumors are rare neoplasms of unknown etiology that are classified as distinct from endometrial stromal tumors on the basis of their morphologic, molecular, and behavioral characteristics. These neoplasms have a variable immunophenotype, sometimes coexpressing epithelial, myoid, and sex cord markers. To date, only 2 cases of uterine tumors resembling ovarian sex cord tumors associated with tamoxifen use have been reported. Here, we report the case of a 49-year-old woman who had been using tamoxifen for 5 years to treat breast cancer. The tumor was initially diagnosed by hysteroscopy biopsy on the basis of morphologic and immunohistochemical features. Hysterectomy revealed a polypoid mass measuring 20 mm. After an 18-month follow-up, the patient remains disease free. Here, we review the clinical, pathologic, and immunohistochemical features of uterine tumors resembling ovarian sex cord tumors and endometrial stromal tumors with a sex cord component associated with tamoxifen treatment.