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720Bfaa8bc7b73a78aff36ddef00 MOLECULAR AND CLINICAL ONCOLOGY 12: 237-243, 2020 A comparative study on the short‑term clinical efficacy of the modified laparoscopic uterine comminution technique and traditional methods XIAOJUN SHI1, LIBING SHI2 and SONGYING ZHANG2 1Department of Gynecology, The First Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314001; 2Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China Received April 28, 2019; Accepted December 13, 2019 DOI: 10.3892/mco.2020.1982 Abstract. To assess the value of the modified laparoscopic diagnosis and treatment. It has thus become one of the most uterine comminution technique in laparoscopic uterine surgery, commonly used techniques in the field of gynecology. Uterine a total of 82 cases of laparoscopic myomectomy were divided fibroids are common benign tumors of the female genital into the traditional group and modified group, according to organs and the prevalence has been reported as high as 20 to a random number table. During the same period, 92 patients 40% (1,2). The widespread application of pulverizers allows who underwent laparoscopic hysterectomy were divided into for removal of uterine fibroids under laparoscopy, which better the conventional group and the modified group, according to a reflects the superiority of minimally invasive techniques. random number table. The patients in the conventional group However, preoperative diagnosis of uterine fibroids and and modified group who underwent laparoscopic uterine uterine sarcoma is very difficult. The incidence of uterine fibroid removal showed no significant differences in the fibroid sarcoma is approximately 0.03 to 1.00% (3). Despite operation time, blood loss or average hospitalization (P>0.05). the dramatic advances in imaging technology, diagnostic There was no significant difference in the operative time or criteria for preoperative suspicious leiomyosarcoma are still average length of hospital stay between patients in the conven- lacking. The direct use of a pulverizer under laparoscopic tional group and modified group who underwent laparoscopic surgery may cause the tumor to spread in the abdominal hysterectomy (P>0.05). In laparoscopic myomectomy, the cavity, leading to the need for secondary surgery and affecting fibroid specimens were placed in a self‑made specimen bag for the prognosis (4). To prevent this, after laparoscopic removal modified uterine comminution. In laparoscopic hysterectomy, of uterine fibroids, the tumor is placed in a specimen bag, and the whole uterus specimen was placed in a self‑made specimen the modified uterine fibroids are comminuted in the bag. If bag and viewed from the vagina. The improved comminution laparoscopic hysterectomy is performed, the isolated uterus technique is simple and feasible, does not increase the opera- is large and difficult to remove from the vagina at one time. tion time or length of hospitalization, and has value for clinical We use a self‑made specimen bag to facilitate smashing of the use. uterus in the lower pocket of the vagina. This procedure is described in the present report. Introduction Patients and methods Laparoscopic minimally invasive surgery is widely used in gynecological operations. Gynecological laparoscopy is a General information. We identified 82 cases of laparoscopic minimally invasive diagnostic and treatment technology that myomectomy in our hospital from April 2017 to October 2018. integrates modern gynecological surgery and endoscopic All patients were diagnosed as intermuscular myoma and subserosal fibroids, according to preoperative examination. The study protocol was approved by the Institutional The First Affiliated Hospital of Jiaxing University (2017‑192), Correspondence to: Dr Xiaojun Shi, Department of Gynecology, and all eligible patients provided written informed consent The First Affiliated Hospital of Jiaxing University, 1882 Central prior to treatment. The inclusion criteria were as follows: South Road, Jiaxing, Zhejiang 314001, P.R. China i) B type‑Ultrasound (transvaginal ultrasound) indicated E‑mail: [email protected] uterine fibroids with a single uterine fibroid greater than 4.0 cm in diameter. ii) For patients with uterine fibroids, preop- Key words: laparoscopic myomectomy, laparoscopic hysterectomy, erative examination indicated dysplasia in the endometrium, a modified laparoscopic uterine smashing technique B type‑ultrasound was performed on the fifth day of menstrua- tion. Diagnostic curettage or hysteroscopy with diagnostic curettage will be performed for those whose endometrium 238 SHI et al: A STUDY OF THE MODIFIED LAPAROSCOPIC UTERINE COMMINUTION TECHNIQUE was still abnormal. Patients can only be recruited when of uterine leiomyoma with degeneration and abundant cells, there was no endometrial cancer showed in the postoperative 18 cases of myopathy, 3 cases of endometrial atypical hyper- pathology. iii) Patients with rapid growth of uterine fibroids plasia, and 1 case of endometrial cancer. The patient was a in short period should receive MRI to exclude the neoplasm perimenopausal woman, who was diagnosed with cervical before they can be recruited. The exclusion criteria included: intraepithelial neoplasia III and received cervical conization. i) Preoperative examination suggested uterine fibroids or The preoperative examination did not indicate abnormal endo- endometerial canceration. ii) Patients that the fibroids were metrium. Because the patient strongly requested to remove found degenerated during the intraoperative stripping and the the uterus, so a minimally invasive surgery was performed. consistency was abnormal, swicthed to receivethe laparatomic Postoperative pathological accidentally showed endometrial surgery. With approval of the ethics committee, 42 cases malignancy. The remaining 43 patients underwent routine were randomly selected for the study. The modified uterine surgery without specimen bags. Including 6 patients (14.0%) smashing technique was used in the experiment. Patients with with hypertension, 4 patients (9.3%) with diabetes, and other disease conditions were most common with cardiovas- 1 patient with chronic bronchitis (2.3%); 4 patient (9.3%) with cular disease and metabolic disorders, including 3 patients two or more complications. Postoperative pathologic exami- (7.1%) with hypertension, 2 patients (4.8%) with diabetes, nation confirmed 31 cases of uterine leiomyoma, including and 1 patient with chronic bronchitis (2.4%); 1 patient (2.4%) 3 cases of uterine leiomyoma with degeneration and abundant with two or more complications. Postoperative pathologic cells, 10 cases of myopathy, 2 cases of endometrial atypical examination confirmed 32 cases of uterine leiomyoma, 9 cases hyperplasia. There were no significant differences in the of uterine leiomyoma with degeneration and abundant cells, baseline data between the two groups (P>0.05). There were 1 case of uterine mucinous myoma. The remaining 40 patients also no significant differences in the uterine weight, operative underwent routine surgery without specimen bags. Including time, or average length of hospital stay between the two groups 2 patients (5.0%) had hypertension, and 1 patient (2.5%) had (P>0.05; Tables III and IV). diabetes. Postoperative pathologic examination confirmed 34 cases of uterine leiomyoma and 6 cases of uterine leio- Specimen bag specifications. The width of our hospital's myoma with degeneration and abundant cells. There were no disposable laparoscopic sheath (disposable suction bag) is significant differences in the baseline data between the two 20 cm, and the end with the white line is selected as the head groups (P>0.05). There were also no significant differences in end of the specimen bag. The length must be larger than the the operation time, blood loss, or average hospital stay between diameter of the fibroids (generally approximately 10‑15 cm). the two groups (P>0.05; Tables I and II). After determining the length, the bottom of the specimen bag We identified 92 patients who underwent laparoscopic is knotted or tied with silk thread (Fig. 1). hysterectomy with difficulty in removing the uterus directly from the vagina from April 2017 to October 2018 in our Operation of specimen bag during uterine myomectomy. hospital. The study protocol was approved by the Institutional After establishment of general anesthesia, the laparoscopic The First Affiliated Hospital of Jiaxing University (2017‑192), instrument was appropriately positioned and the pre‑made and all eligible patients provided written informed consent specimen bag was placed into the abdominal cavity through prior to treatment. The inclusion criteria were as follows: a 10‑mm trocar. The bag was then placed in the right fossa i) According to the indications of hysteretomy. ii) If there iliaca and the mouth of the bag was opened. Laparoscopic were indications for removal of uterus and the preoperative myomectomy was then routinely performed. After the fibroids examination showed abnormalities in the endometrium, a B had been completely removed, the fibroid specimens were type‑Ultrasound was performed on the fifth day of menstrua- placed directly into the specimen bag. The surgical wound was tion. Diagnostic curettage or hysteroscopy with diagnostic routinely sutured, and the 10‑mm puncture hole in the left lower curettage will be performed for those whose endometrium was abdomen was enlarged to 15 mm. The end of the
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