Pregnancy outcome after laparoscopic myomectomy.

PURPOSE OF INVESTIGATION: Main purpose of this study was to analyze the reproductive and obstetrical outcome as delivery mode and incidence of major complications (uterine bleeding and uterine rupture) after laparoscopic myomectomy. MATERIALS AND METHODS: The authors conducted an observational study in patients who underwent laparoscopic myomectomy. Inclusion criteria were: surgery performed for single and or multiple myomas sized between five and 15 cm and pregnancy desire. Exclusion criteria were: surgery for pedunculated myomas and male or tubal infertility. Collected data on pregnancy desire, success in obtaining pregnancy surgical interval time before pregnancy, performing assisted reproductive medicine, gestational weeks, mode of delivery, indicating a possible cesarean section, and complications. On collected data the authors calculated pregnancy and abortion rates. RESULTS: Among patients aged between 19 and 42 years who answered a telephonic questionnaire, the authors selected 185 patients with pregnancy willing. A total number of 426 myomas were removed; 115 (62.2%) patients reported 151 pregnancies, nine in a total of 17 patients achieved it with reproductive assistance, 38 pregnancy ended in abortion, and two had an ectopic implantation. The authors finally reported 111 successful pregnancy, with seven preterm deliveries (6.3%). Mode of delivery had been cesarean section in 69 cases (63.4%) and vaginal delivery in 42 cases (36.6%), with a respective mean interval time between surgery and delivery of 24.6 +/- 20.0 months and 19.2 +/- 13.3 months. CONCLUSION: Laparoscopic myomectomy proved to be an effective procedure feasible for women who wish to become pregnant with a subsequent good reproductive outcomes, both in terms of pregnancy and abortion rates that were comparable with the literature. If laparoscopic suturing of the fovea myometralis is adequate, there are no contraindications for vaginal delivery, regardless of the patient's age, the number, size, and location of the myomas removed.

Thermal balloon ablation versus transcervical endometrial resection: evaluation of postoperative pelvic pain in women treated for dysfunctional uterine bleeding.

PURPOSE OF THE STUDY: To evaluate postoperative pain after mini-invasive surgical treatment for dysfunctional uterine bleeding (DUB) with transcervical endometrial resection or thermal ablation balloon. MATERIALS AND METHODS: A longitudinal observational study, analyzing 47 women affected by DUB who underwent endometrial ablation was conducted. The authors collected evaluation of pelvic pain at one and four hours after intervention and the individual necessity of analgesics. After 30 days, all patients underwent a gynecological visit to evaluate postoperative outcome. RESULTS: Pelvic pain was higher one and four hours after procedure in thermal balloon ablation group, and patients in the same group required more analgesic rescue dose. There were no complications such as uterine perforation, heavy blood loss or thermal injuries with both the procedures. CONCLUSION: Thermal balloon ablation appears a more painful procedure than endometrial resection, both in the immediate postsurgical time and 30 days after surgery. Ad hoc anaesthesiologic and analgesic protocol should be adopted to ensure quick recovery and good acceptance of the procedure.

Laparoscopic hysterectomy: really so risky to a vaginal cuff dehiscence?

PURPOSE OF INVESTIGATION: The authors report their experience with vaginal vault suturing procedure in patients that underwent total laparoscopic hysterectomy (TLH) for benign diseases. Vaginal vault colpotomy and closure were only laparoscopically carried out. MATERIALS AND METHODS: Longitudinal retrospective study was conducted in 550 patients, affected by gynaecological benign pathologies, that underwent TLH were enrolled. Information about age, body mass index, parity, corticosteroid therapy, previous pelvic surgery, smoking, diabetes, menopausal status, and procedure characteristics (operating time, blood loss, uterus weight, postoperative recovery time, and adverse outcomes) were collected. Postoperative complications and adverse outcomes were recorded. RESULTS: Only one case (0.2%,) of vaginal cuff dehiscence (VCD) occurred four weeks after surgery, which was quickly laparoscopically repaired with interrupted intracorporeal knots. The trigger event was sexual intercourse in a patient affected by systemic lupus erythematosus (SLE). No cases of VCD presented in patients with other considered comorbidities. CONCLUSION: A careful technique could further decrease the incidence of postoperative vaginal cuff dehiscence, regardless of laparoscopic or vaginal suture approach.