A Multicenter Study Evaluating the Effect of Ulipristal Acetate during Myomectomy
| Autor: | Marta Wais, Sabrina Lee, Ally Murji, G Liu, Melissa Tai, A. Pham |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
medicine.medical_specialty Norpregnadienes Adolescent medicine.medical_treatment Antineoplastic Agents Laparoscopic myomectomy Hysteroscopy Tertiary care Young Adult 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Blood loss Laparotomy Ulipristal acetate Uterine Myomectomy medicine Humans Prospective Studies Aged 030219 obstetrics & reproductive medicine Leiomyoma medicine.diagnostic_test business.industry Obstetrics and Gynecology Myoma Middle Aged medicine.disease Surgery chemistry Multicenter study 030220 oncology & carcinogenesis Uterine Neoplasms Female Laparoscopy business |
| Zdroj: | Journal of Minimally Invasive Gynecology. 25:514-521 |
| ISSN: | 1553-4650 |
| DOI: | 10.1016/j.jmig.2017.10.016 |
| Popis: | Study Objective To compare surgical experience at myomectomy between patients with myomas pretreated with ulipristal acetate versus no pretreatment. Design A prospective, observational, multicenter study of myomectomy procedures by any route (hysteroscopic, laparoscopic, or laparotomy) (Canadian Task Force classification II-2). Setting Five university-affiliated hospitals including tertiary care and community sites. Patients Any patient who underwent hysteroscopic, laparotomic, or laparoscopic myomectomy regardless of medical pretreatment. Interventions Surgeons completed a Web-based questionnaire after each myomectomy procedure. Surgeons evaluated visualization, the myoma-myometrium relationship, extrusion, fluid deficit, blood loss, and overall ease of hysteroscopic myomectomies. For laparotomic/laparoscopic myomectomies, plane delineation, myoma separation, blood loss, and overall ease were assessed. The total surgical experience score was calculated by summing the values for each subscale. Measurements and Main Results A total of 309 myomectomies were evaluated by 52 surgeons (response rate = 83%) at 5 institutions. Of 140 hysteroscopic myomectomies, 84 (60%) were performed without pretreatment, 29 (21%) after ulipristal acetate pretreatment, and 27 (19%) after pretreatment with gonadotropin-releasing hormone agonist/other. Of 169 laparotomic/laparoscopic myomectomies, 104 (62%) were performed without pretreatment, 46 (27%) after ulipristal acetate, and 19 (11%) after gonadotropin-releasing hormone agonist/other. The mean surgical experience score (±standard deviation) was comparable between the no pretreatment and ulipristal acetate groups for hysteroscopic myomectomies (13.8 ± 2.2 vs 13.3 ± 2.2, p = .35) and laparotomic/laparoscopic myomectomies (12.9 ± 4.1 vs 12.1 ± 4.2, p = .30). Compared with no pretreatment, more laparotomic/laparoscopic myomectomies after ulipristal acetate pretreatment were associated with difficult delineation of surgical planes (22 [47.8%] vs 23 [22.1%], p = .002) and difficult myoma separation (20 [43.5%] vs 21 [20.2%], p = .003). More myomas were described as soft with ulipristal acetate pretreatment (14 [30.4%] vs 17 [16.4%], p = .049). The rates of profuse/abundant endometrium during hysteroscopy were similar between the no pretreatment (21 [25.0%]) and ulipristal acetate (7 [24.1%], p = .93) groups. Conclusion Despite differences in surgical nuances, the overall myomectomy experience was not negatively affected by ulipristal acetate pretreatment. |
| Databáze: | OpenAIRE |
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