Uterine Suspension With Adjustable Sutures for Difficult Laparoscopic Myomectomy

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• 作者：Kuo-Hu Chen ; MD ; PhD^a ; ^b ; ^{alexgfctw@yahoo.com.tw} ; Kok-Min Seow ; MD ; PhD^c ; ^d ; Li-Ru Chen ; MD ; MSc^e ; ^f
• 关键词：Laparoscopic myomectomy ; Fibroid ; Uterine leiomyoma ; Uterine suspension with adjustable sutures
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：24
• 期：2
• 页码：264-271
• 全文大小：962 K
• 卷排序：24

文摘

To assess whether transabdominal uterine suspension with adjustable sutures (USAS) is beneficial when performed concomitantly with laparoscopic myomectomy in patients with unfavorably localized leiomyomas in whom uterine manipulators are not an option.DesignA retrospective cohort study (Canadian Task Force classification II-2).SettingA university teaching hospital.PatientsPatients (N = 158) with posterior deep intramural, intraligamental, or cervical leiomyomas; 81 patients underwent USAS (suspension group), and 77 patients did not (control group) concomitantly with laparoscopic myomectomy.InterventionsTransabdominal USAS was performed for all eligible patients undergoing laparoscopic myomectomy using a 2-0 synthetic, monofilament, nonabsorbable polypropylene suture. One end of the double-headed straight needles of the polypropylene suture was inserted into the pelvic cavity through the abdomen to “lift” or “retract” the uterus to allow for the main tumor to be completely exposed and excised.Measurements and Main ResultsThe average time to create USAS was 2.5 minutes. For the suspension and control groups, the average number of abdominal ports was 3 and 4.4 (p < .001), the average blood loss was 96.3 and 201.5 mL (p < .001), and the average operative time was 50.8 and 91.2 minutes (p < .001), respectively. There was no significant difference in complications (4.9% vs 9.1%, p = .303), but there was a significant difference in conversion to laparotomy (1.2% vs 10.4%, p = .009). At the 3-year follow-up, there were no significant differences in gynecologic and reproductive outcomes, including leiomyoma recurrence, uterine rupture, and pregnancy and live birth rates. The ratio of conversion to laparotomy (odds ratio = 0.108; 95% confidence interval, 0.013–0.884) was much lower in the suspension group.ConclusionUSAS is an easy, safe, and feasible alternative to uterine manipulation when performed concomitantly with laparoscopic myomectomy for unfavorably localized uterine leiomyomas.