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Cho, Jung, Kim, Kim, Kim, Jung, Rhew, Kim, Chun, Lim, Kwon, and Song: Laparoscopic myomectomy: Presurgical classification to evaluate the validity of laparoscopic surgical treatment
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(3): 172-179.

Published online: 15 March 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.3.172

Laparoscopic myomectomy: Presurgical classification to evaluate the validity of laparoscopic surgical treatment

Hyun Hee Cho, MD, Yun Ji Jung, MD, Mee Ran Kim, MD, Jang Heub Kim, MD, Min Jung Kim, MD, In Chul Jung, MD, Young Ok Rhew, MD, En Jung Kim, MD, Gun Yung Chun, MD, Yong Taek Lim, MD, Dong Jin Kwon, MD, Jae Yean Song, MD

Department of Obstetrics and Gynecology, The Catholic University of Korea School of Medicine, Seoul, Korea.

Corresponding authors: Jang Heub Kim, MD. Department of Obstetrics and Gynecology, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-6175, Fax: +82-2-595-1549, janghkim@catholic.ac.kr, Mee Ran Kim, MD. Department of Obstetrics and Gynecology, The Catholic University of Korea School of Medicine, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea. Tel: +82-2-2258-7606, Fax: +82-2-595-1549, mrkim@catholic.ac.kr

Received 28 September 2011       Revised 25 November 2011       Accepted 12 December 2011

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

To evaluate if the preoperative scoring system effect the post operative prognosis and type of operation.

Methods

Patients who took myomectomy in Seoul St. Mary's Hospital were enrolled this study. Retrospective analysis of preoperative leiomyoma scroings with imaging study were done. Prognostic factors were as follows: hospital days, bleeding amount, transfusion rate, operation time. Catholic Medical Center fibroid score system (CMFS) was used for analysis of fibroid.

Results

Patients were grouped into three as CMFS total score. Group I: scores<11, group II: 11-20, group III: 20<. Bleeding amount was 106.0 mL in group I, 132.3 mL in group II and 135.6 mL in group III. The bleeding amount and transfusion rate were significantly low in group I (P<0.05). Total score of CMFS had significant effect to type of operation (odds ratio, 1.339; 95% confidence interval, 1.237 to 1.449, P<0.0001; area under curve, 0.810) and accuracy was 76.6%. Topographic score and size score effect significantly to bleeding amount and operation time Topography score coefficient of determination (CD, 0.90, 0.82, P<0.01; size score CD, 1, 0.98, P<0.01). Repair score showed significant correlation with operation time, but showed no correlation with bleeding amount and operation time. Topographic score, size score, repair score showed significant effect on type of operation (P<0.01).

Conclusion

Systematic scoring systems like CMFS help to predict the difficulties and bleeding complications after myomectomy. Further study about preoperative the prognostic factors and accurate presurgical scoring system were helpful for the decision of type of operation.

Keywords: Myomectomy, Prognosis, Scoring

Figures and Tables

Fig. 1
Method of myomectomy according to total Catholic Medical Center fibroid scoring system score.
kjog-55-172-g001
Fig. 2
Coefficient of determination of topography score vs operation time and estimated blood loss. R2, coefficient of determination; Time, operation time; EBL, estimated blood loss.
kjog-55-172-g002
Fig. 3
Coefficient of determination of size vs operation time and estimated blood loss. R2, coefficient of determination; Time, operation time; EBL, estimated blood loss.
kjog-55-172-g003
Table 1
Prognostic factors according to total scores of leiomyoma
kjog-55-172-i001

T/F, transfusion; Op, operation; EBL, estimated blood loss; POD, post operative day.

Table 2
Using predefined scores (univariate analysis) of total score
kjog-55-172-i002

OR, odds ratio; CI, confidence interval; AUC, area under curve.

References

1. Falcone T, Bedaiwy MA. Minimally invasive management of uterine fibroids. Curr Opin Obstet Gynecol. 2002. 14:401–407.
2. Holub Z. Laparoscopic myomectomy: indications and limits. Ceska Gynekol. 2007. 72:64–68.
3. Agdi M, Tulandi T. Endoscopic management of uterine fibroids. Best Pract Res Clin Obstet Gynaecol. 2008. 22:707–716.
4. 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.
5. Lasmar RB, Barrozo PR, Dias R, Oliveira MA. Submucous myomas: a new presurgical classification to evaluate the viability of hysteroscopic surgical treatment: preliminary report. J Minim Invasive Gynecol. 2005. 12:308–311.
6. Deprez PH, Bergman JJ, Meisner S, Ponchon T, Repici A, Dinis-Ribeiro M, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010. 42:853–858.
7. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005. 83:1–23.
8. Glasser MH. Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol. 2005. 12:275–283.
9. Reich H, Thompson KA, Nataupsky LG, Grabo TN, Sekel L. Laparoscopic myomectomy: an alternative to laparotomy myomectomy or hysterectomy? Gynaecol Endosc. 1997. 6:7–12.
10. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996. 174:654–658.
11. Miller CE, Johnston M, Rundell M. Laparoscopic myomectomy in the infertile woman. J Am Assoc Gynecol Laparosc. 1996. 3:525–532.
12. Daraï E, Dechaud H, Benifla JL, Renolleau C, Panel P, Madelenat P. Fertility after laparoscopic myomectomy: preliminary results. Hum Reprod. 1997. 12:1931–1934.
13. Marret H, Chevillot M, Giraudeau B. Study Group of the French Society of Gynaecology and Obstetrics (Ouest Division). Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy. Acta Obstet Gynecol Scand. 2006. 85:324–329.
14. Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C. Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod. 2001. 16:1726–1731.
15. Frishman GN, Jurema MW. Myomas and myomectomy. J Minim Invasive Gynecol. 2005. 12:443–456.
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