The Significant Risk Factors of Intra-Operative Hemorrhage during Laparoscopic Myomectomy: A Systematic Review

Zaki Sleiman, Rania El Baba, Simone Garzon, Aline Khazaka, Zaki Sleiman, Rania El Baba, Simone Garzon, Aline Khazaka

Abstract

Laparoscopic myomectomy (LM) is becoming increasingly common in the management of uterine myomas and is usually offered regardless of the number, location, and size of the myomas. It has a generally low rate of periprocedural complications and is preferred to laparotomy for several reasons that are not limited to decreased length of hospital stay, number of sutures, smaller incisions, and decreased pain. However, blood loss during LM remains a challenge. To be able to stratify patients and provide better management after LM, it is crucial to identify these predictors of blood loss. Therefore, the aim of this review was to identify the risk factors for periprocedural blood loss after laparoscopic uterine myomectomy. According to our data synthesis, age, body mass index, and phase of the menstrual cycle do not seem to affect the blood loss during LM. Conversely, size and number of myomas, as well as operative time, was directly related to the increase of blood loss.

Keywords: Hemoglobin drop; laparoscopy; myomectomy; systematic review.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Gynecology and Minimally Invasive Therapy.

Figures

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Figure 1
Flow diagram of the search process

References

    1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol. 2003;188:100–7.
    1. Laganà AS, Vergara D, Favilli A, La Rosa VL, Tinelli A, Gerli S, et al. Epigenetic and genetic landscape of uterine leiomyomas: A current view over a common gynecological disease. Arch Gynecol Obstet. 2017;296:855–67.
    1. Milazzo GN, Catalano A, Badia V, Mallozzi M, Caserta D. Myoma and myomectomy: Poor evidence concern in pregnancy. J Obstet Gynaecol Res. 2017;43:1789–804.
    1. Levast F, Legendre G, Bouet PE, Sentilhes L. Management of uterine myomas during pregnancy. Gynecol Obstet Fertil. 2016;44:350–4.
    1. Vitale SG, Padula F, Gulino FA. Management of uterine fibroids in pregnancy: Recent trends. Curr Opin Obstet Gynecol. 2015;27:432–7.
    1. Borah BJ, Nicholson WK, Bradley L, Stewart EA. The impact of uterine leiomyomas: A national survey of affected women. Am J Obstet Gynecol. 2013;209:319.e1–20.
    1. Babacan A, Gun I, Kizilaslan C, Ozden O, Muhcu M, Mungen E, et al. Comparison of transvaginal ultrasonography and hysteroscopy in the diagnosis of uterine pathologies. Int J Clin Exp Med. 2014;7:764–9.
    1. Vitale SG, Sapia F, Rapisarda AMC, Valenti G, Santangelo F, Rossetti D, et al. Hysteroscopic morcellation of submucous myomas: A Systematic review. Biomed Res Int. 2017;2017:6848250.
    1. Donnez J, Arriagada P, Donnez O, Dolmans MM. Current management of myomas: The place of medical therapy with the advent of selective progesterone receptor modulators. Curr Opin Obstet Gynecol. 2015;27:422–31.
    1. Tinelli A, Gasbarro N, Lupo P, Malvasi A, Tsin DA, Davila F, et al. Safe introduction of ancillary trocars. JSLS. 2012;16:276–9.
    1. Vitale SG, Laganà AS, Noventa M, Giampaolino P, Zizolfi B, Butticè S, et al. Transvaginal bilateral sacrospinous fixation after second recurrence of vaginal vault prolapse: Efficacy and impact on quality of life and sexuality. Biomed Res Int. 2018;2018:5727165.
    1. Rahn DD, Mamik MM, Sanses TV, Matteson KA, Aschkenazi SO, Washington BB, et al. Venous thromboembolism prophylaxis in gynecologic surgery: A systematic review. Obstet Gynecol. 2011;118:1111–25.
    1. Alves J, Puga M, Fernandes R, Pinton A, Miranda I, Kovoor E, et al. Laparoscopic management of ureteral endometriosis and hydronephrosis associated with endometriosis. J Minim Invasive Gynecol. 2017;24:466–72.
    1. D'Silva EC, Muda AM, Safiee AI, Ghazali WA. Five-year lapsed: Review of laparoscopic myomectomy versus open myomectomy in Putrajaya hospital. Gynecol Minim Invasive Ther. 2018;7:161–6.
    1. Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, et al. Laparoscopic versus open myomectomy – A meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145:14–21.
    1. Malzoni M, Sizzi O, Rossetti A, Imperato F. Laparoscopic myomectomy: A report of 982 procedures. Surg Technol Int. 2006;15:123–9.
    1. Sinha R, Hegde A, Mahajan C, Dubey N, Sundaram M. Laparoscopic myomectomy: Do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invasive Gynecol. 2008;15:292–300.
    1. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol. 2007;14:453–62.
    1. Paul GP, Naik SA, Madhu KN, Thomas T. Complications of laparoscopic myomectomy: A single surgeon's series of 1001 cases. Aust N Z J Obstet Gynaecol. 2010;50:385–90.
    1. Clark NV, Wang KC, Opoku-Anane J, Hill-Lydecker CI, Vitonis AF, Einarsson JI, et al. The menstrual cycle and blood loss during laparoscopic myomectomy. Acta Obstet Gynecol Scand. 2017;96:1446–52.
    1. Gingold J, Flyckt R. Identification of factors associated with laparoscopic myomectomy transfusion requirement. J Minim Invasive Gynecol. 2017;24:S175.
    1. Watrowski R, Jäger C, Forster J. Predictors of postoperative hemoglobin drop after laparoscopic myomectomy. Wideochir Inne Tech Maloinwazyjne. 2017;12:81–7.
    1. Walid MS, Heaton RL. Laparoscopic myomectomy: An intent-to-treat study. Arch Gynecol Obstet. 2010;281:645–9.
    1. Saccardi C, Gizzo S, Noventa M, Ancona E, Borghero A, Litta PS, et al. Limits and complications of laparoscopic myomectomy: Which are the best predictors? A large cohort single-center experience. Arch Gynecol Obstet. 2014;290:951–6.
    1. George A, Eisenstein D, Wegienka G. Analysis of the impact of body mass index on the surgical outcomes after robot-assisted laparoscopic myomectomy. J Minim Invasive Gynecol. 2009;16:730–3.
    1. Cho H. Vol. 8. London: United Kingdom Conference Publication; 2011. Prediction of Postoperative Anemia Following Laparoscopic Myomectomy. Gynecol Surgery Conference 20th Annu Congr ESGE; pp. S159–60.
    1. Catanzarite T, Vieira B, Hackett N, Kim JY, Milad MP. Longer operative time during laparoscopic myomectomy is associated with increased 30-day complications and blood transfusion. J Gynecol Surg. 2016;32:11–8.
    1. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle – Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-Analyses. 2001. [Last accessed on 2019 Mar 01]. Available from: .
    1. Laganà AS, Vitale SG, Palmara V, Ban Frangež H, Triolo O. Transvaginal specimen removal in minimally invasive surgery: Feasibility and possible complications during the incision of the posterior vaginal wall. World J Urol. 2017;35:1155–6.
    1. Peri L, Musquera M, Vilaseca A, Garcia-Cruz E, Ribal MJ, Carrión A, et al. Perioperative outcome and female sexual function after laparoscopic transvaginal NOTES-assisted nephrectomy. World J Urol. 2015;33:2009–14.
    1. Laganà AS, Vitale SG, Trovato MA, Palmara VI, Rapisarda AM, Granese R, et al. Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: Rationale and potential treatment options. Biomed Res Int. 2016;2016:3617179.
    1. Chen L, Zhu D, Wu Q, Yu Y. Fertility outcomes after laparoscopic salpingectomy or salpingotomy for tubal ectopic pregnancy: A retrospective cohort study of 95 patients. Int J Surg. 2017;48:59–63.
    1. Vitale SG, Laganà AS, Gulino FA, Tropea A, Tarda S. Prosthetic surgery versus native tissue repair of cystocele: Literature review. Updates Surg. 2016;68:325–9.
    1. Monti M, Schiavi MC, Colagiovanni V, Sciuga V, D’oria O, Cerone G, et al. Effectiveness, quality of life and sexual functions in women with anterior compartment prolapse treated by native tissue repair. Minerva Ginecol. 2019;71:18–24.
    1. Vitale SG, Caruso S, Rapisarda AM, Valenti G, Rossetti D, Cianci S, et al. Biocompatible porcine dermis graft to treat severe cystocele: Impact on quality of life and sexuality. Arch Gynecol Obstet. 2016;293:125–31.
    1. Mallick R, Odejinmi F. Pushing the boundaries of laparoscopic myomectomy: A comparative analysis of peri-operative outcomes in 323 women undergoing laparoscopic myomectomy in a tertiary referral centre. Gynecol Surg. 2017;14:22.
    1. Tanos V, Berry KE, Frist M, Campo R, DeWilde RL. Prevention and management of complications in laparoscopic myomectomy. Biomed Res Int. 2018;2018:8250952.
    1. Iavazzo C, Mamais I, Gkegkes ID. Use of misoprostol in myomectomy: A systematic review and meta-analysis. Arch Gynecol Obstet. 2015;292:1185–91.
    1. Raba G, Kotarski J, Szczupak K, Obloza B, Fudali-Walczak M. Uterus banding with the Osada method effectively reduces intraoperative blood loss during myomectomy. Minim Invasive Ther Allied Technol. 2016;25:43–7.
    1. Chang WC, Chu LH, Huang PS, Huang SC, Sheu BC. Comparison of laparoscopic myomectomy in large myomas with and without leuprolide acetate. J Minim Invasive Gynecol. 2015;22:992–6.
    1. Palomba S, Pellicano M, Affinito P, Di Carlo C, Zullo F, Nappi C. Effectiveness of short-term administration of tibolone plus gonadotropin-releasing hormone analogue on the surgical outcome of laparoscopic myomectomy. Fertil Steril. 2001;75:429–33.
    1. Ferrero S, Vellone VG, Barra F, Scala C. Ulipristal acetate before hysteroscopic and laparoscopic surgery for uterine myomas: Help or hindrance? Gynecol Obstet Invest. 2018:1–3. doi: 10.1159/000495347.
    1. Ferrero S, Vellone VG, Barra F. Pharmacokinetic drug evaluation of ulipristal acetate for the treatment of uterine fibroids. Expert Opin Drug Metab Toxicol. 2018;14:107–16.
    1. Ferrero S, Alessandri F, Vellone VG, Venturini PL, Leone Roberti Maggiore U. Three-month treatment with ulipristal acetate prior to laparoscopic myomectomy of large uterine myomas: A retrospective study. Eur J Obstet Gynecol Reprod Biol. 2016;205:43–7.
    1. Amemiya K, Adachi K, Sasamoto N, Yamamoto Y. Transumbilical extraction of 151-300-g myomas without morcellator versus conventional laparoscopic myomectomy with power morcellator. Gynecol Minim Invasive Ther. 2017;6:162–6.

Source: PubMed

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