Investigating the use of radiofrequency myolysis (RFM) for the treatment of fibroids through less invasive access by combining transvaginal ultrasound, hysteroscopy and laparoscopy.
Fifty-four ...premenopausal women with 106 symptomatic uterine myomas. Patients underwent RFM in three ways: Vaginal Ultrasound-guided RFM (VU-RFM), Laparoscopic RFM (L-RFM) and Hysteroscopic-RFM (H-RFM). The mean patient age was 43 years; 52 symptomatic uterine myomas were subserosal, 44 intramural and 10 submucosal. The outcomes evaluated at 1 and 12 months after RFM were myoma size (volume-diameter), "Uterine Fibroid Symptom and Quality of Life (UFS-QOL)" questionnaire and a 10-point Visual Analogue Scale (VAS). The therapy was completed with a single ablation in all patients, no complication was registered. The average number of fibroids treated per intervention was two with the use of different accesses: 64/106 VU-RFMs (60.4%), 32/106 L-RFMs (30.2%) and 10/106 H-RFMs (9.4%).
Volume and diameter of fibroids were significantly reduced by, respectively, 51.3% and 20.1% in the first 30 days post-intervention (
< 0.001) up to a maximum of 73.5% and 37.1% after the second follow-up visit at 12 months (
< 0.001). A similar trend was shown in terms of disability with a progressive and significant reduction of symptoms (menorrhagia, dysmenorrhea, dyspareunia and pollakiuria) demonstrated by percentage variation of UFS-QOL Symptom Severity and VAS scores to -74.3% and -45.3% as well as -84.9% and -74.3%, respectively, at 1 and 12 months after RFM (
< 0.001). An overall improvement in the quality of life was also demonstrated by a significant increase in the UFS-QOL total score of +38.2% in the first 30 days post-intervention up to +44.9% after the second follow-up visit at 12 months (
< 0.001). The overall average surgery time of the RFM for each patient was 48 minutes, and the time to treat each fibroid by Vaginal Ultrasound-guided RFM (23 min) was found to be significantly less than those of laparoscopy or hysteroscopy (respectively 35 and 34 min) (
< 0.05). An electromagnetic virtual needle tracking system (VNTS) was successfully tested during the RFM procedures, and real-time contrast-enhanced ultrasound (CEUS) has proven to be effective in determining the duration of myolysis through the identification of eventual residual areas of enhancement within the fibroids.
Radiofrequency can be considered a minimally invasive and safe procedure for the treatment of uterine myomas through the customization and possible combination of transvaginal, laparoscopic or hysteroscopic accesses. The standardization of the ablation technique with pre-intervention biopsy and new technologies such as VNTS and CEUS spares healthy uterine tissue and may change the future management of symptomatic uterine fibroids.
Fertility after bowel resection for endometriosis Ferrero, Simone, M.D; Anserini, Paola, M.D; Abbamonte, Luiza Helena, M.D ...
Fertility and sterility,
07/2009, Letnik:
92, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Objective To determine the pregnancy rate after bowel resection for rectosigmoid endometriosis. Design Prospective cohort study. Setting University hospital. Patient(s) Forty-six symptomatic women ...with bowel endometriosis requiring colorectal resection. Intervention(s) Bowel resection by either laparoscopy or laparotomy. Main Outcome Measure(s) Pregnancy rate after surgery. Result(s) The pregnancy rate was higher in women who underwent bowel resection by laparoscopy (57.6%) than in those who underwent laparotomy (23.1%). No significant difference was observed in pregnancy rate and mode of conception between women with different fertility status before bowel resection. Women who conceived were significantly younger than those who did not conceive; only 26.7% of women aged ≥35 years conceived after bowel resection. Uterine adenomyosis was more frequently present in women who did not conceive than in those who conceived. Infertile women who conceived had a shorter length of infertility before surgery than those who did not conceive. Conclusion(s) Laparoscopic colorectal resection is less likely to impact negatively on fertility than the laparotomy approach. Previous laparotomies, age ≥35 years, uterine adenomyosis, and longer duration of infertility before surgery are associated with decreased pregnancy rate.
Objective To investigate the expression of estrogen receptors (ERs) and inflammatory cytokines in macrophages obtained from peritoneal fluid (PF) of women with endometriosis. Design Comparative ...immunocytochemical study. Setting University hospital. Patient(s) Thirty women with endometriosis and 22 controls. Intervention(s) The PF samples were collected at laparoscopy. Main Outcome Measure(s) The expression of ERα, ERβ, differentiation markers (CD68, NCL-MACRO, HAM56), and inflammatory cytokines (interleukin IL-1β, tumor necrosis factor-α TNF-α, IL-6) in PF macrophages was determined. Result(s) The expression of CD68, NCL-MACRO, HAM56, TNFα, IL-6, and IL-1β was significantly higher in PF macrophages obtained from women with endometriosis than in controls. The ERα and ERβ had significantly higher expression in macrophages of women with endometriosis than in controls. A positive correlation was observed between the expression of ERα and ERβ both in women with and without endometriosis. The ERα expression was positively correlated with the expression of inflammatory cytokines in women with endometriosis but not in controls; ERβ expression was correlated to the expression of inflammatory cytokines in the both groups. Conclusion(s) There is a correlation between the expression of ERβ and proinflammatory cytokines both in women with and without endometriosis. The expression of ERα correlates with cytokine production selectively in women with endometriosis but not in controls.
To estimate the effectiveness of unidirectional knotless barbed suture and continuous suture with intracorporeal knots in the repair of uterine wall defects during laparoscopic myomectomy.
Randomized ...clinical study (Canadian Task Force Classification I).
Single-center study in a university hospital.
This study enrolled 44 women who underwent laparoscopic myomectomy.
In accord with to the randomization, the uterine wall defects were closed either with a continuous suture with intracorporeal knots (group V) or a unidirectional knotless barbed suture (group L).
The time required to suture the uterine wall defect was significantly lower in group L (11.5 ± 4.1 minutes) than in group V (17.4 ± 3.8 minutes; p <.001). However, no significant difference was observed in the operative time between the 2 study groups. The intraoperative blood loss was significantly lower in group L than in group V (p =.004). The degree of surgical difficulty was significantly lower in group L (3.7 ± 1.1) than in group V (6.1 ± 2.1; p <.001).
The unidirectional knotless barbed suture may facilitate the suture of uterine wall defects during laparoscopic myomectomy. When compared with continuous suture and intracorporeal knots, the barbed suture reduces the time required to suture the uterine wall defect and the intraoperative blood loss.
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