Our Summary

This research paper is about a study that compares two different methods of removing uterine fibroids, or benign tumors in the womb, using a minimally invasive surgical procedure called laparoscopic myomectomy.

The first method is called ‘intracorporeal uncontained power morcellation’, where the fibroids are broken down into smaller pieces inside the body and then removed. However, this method has the risk of spreading benign tissues or even malignant cells, if present, which can lead to a worse prognosis.

The second method, called ‘in-bag extracorporeal manual morcellation’, involves placing the fibroids in a bag within the body, breaking them down into smaller pieces, and then removing the bag. This method theoretically reduces the risk of spreading tissues or cells.

The study was aimed at evaluating the effectiveness and safety of these two methods. The researchers examined factors such as operative times, ease of morcellation, length of hospital stay, postoperative pain, conversion to laparotomy, and postoperative diagnosis of leiomyosarcoma (a rare and aggressive form of cancer that originates in smooth muscle cells).

However, the study only included two trials involving 176 premenopausal women, and the evidence was found to be of very low quality due to several limitations, including small sample sizes, limited sites in high-income settings and countries, wide confidence intervals, and few events.

The researchers concluded that there is limited data on the effectiveness and safety of in-bag morcellation compared to uncontained power morcellation. They found no significant difference in operative time or ease of morcellation between the two methods. No cases of leiomyosarcoma were diagnosed postoperatively in either group. The authors advocate for larger, well-planned, and executed trials to provide more concrete evidence.

FAQs

  1. What are the two methods of removing uterine fibroids discussed in the study?
  2. What are the potential risks associated with the ‘intracorporeal uncontained power morcellation’ method?
  3. What were the conclusions of the study regarding the effectiveness and safety of the ‘in-bag extracorporeal manual morcellation’ method versus the ‘intracorporeal uncontained power morcellation’ method?

Doctor’s Tip

A doctor might advise a patient considering myomectomy to discuss the risks and benefits of both intracorporeal uncontained power morcellation and in-bag extracorporeal manual morcellation with their healthcare provider. It is important to weigh the potential risk of tissue or cell spreading with the convenience of the procedure. Additionally, patients should be aware of the limitations of the current evidence and the need for further research in this area.

Suitable For

Patients who are typically recommended myomectomy are those experiencing symptoms such as heavy menstrual bleeding, pelvic pain, pressure on the bladder or rectum, and infertility due to uterine fibroids. These patients may have tried other conservative treatments such as medication or hormonal therapy without success, and may desire to preserve their fertility. Myomectomy is often recommended for women who wish to maintain their uterus and potential for future pregnancy.

Timeline

Before the myomectomy procedure, a patient may experience symptoms such as heavy menstrual bleeding, pelvic pain, and pressure. They may have undergone imaging tests such as ultrasound or MRI to confirm the presence of uterine fibroids. The patient would have also met with their healthcare provider to discuss treatment options and the risks and benefits of surgery.

During the myomectomy procedure, the patient would be under general anesthesia. The surgeon would make small incisions in the abdomen and use a laparoscope to remove the fibroids. The type of morcellation method used would depend on the surgeon’s preference and expertise.

After the myomectomy, the patient would typically stay in the hospital for a day or two for monitoring. They may experience pain and discomfort, which can be managed with pain medication. The patient would be advised to rest and avoid strenuous activities for a few weeks. Follow-up appointments with the healthcare provider would be scheduled to monitor recovery and address any concerns.

Overall, a patient undergoing myomectomy can expect a thorough evaluation of their symptoms, a discussion of treatment options, a minimally invasive surgical procedure, and postoperative care to ensure a smooth recovery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about myomectomy include:

  1. What are the different methods of removing uterine fibroids, and what are the benefits and risks associated with each method?
  2. Which method of myomectomy do you recommend for me, and why?
  3. Have you performed both intracorporeal uncontained power morcellation and in-bag extracorporeal manual morcellation procedures before? How experienced are you with each method?
  4. What are the potential complications or side effects of the myomectomy procedure I will undergo?
  5. How long will the recovery process be after myomectomy, and what can I expect in terms of postoperative pain and discomfort?
  6. Will there be a risk of spreading benign tissues or malignant cells during the procedure, and how will this risk be minimized?
  7. What is the likelihood of needing a conversion to laparotomy during the procedure, and how is this decision made?
  8. How will my postoperative care be managed, and what follow-up appointments will be necessary?
  9. Are there any specific factors about my medical history or condition that may affect the success of the myomectomy procedure?
  10. Are there any alternative treatments or procedures that I should consider before deciding on myomectomy?

Reference

Authors: Zullo F, Venturella R, Raffone A, Saccone G. Journal: Cochrane Database Syst Rev. 2020 May 6;5(5):CD013352. doi: 10.1002/14651858.CD013352.pub2. PMID: 32374421