Northwestern University, Feinberg School of Medicine, Division of Minimally Invasive Gynecology, 250 E Superior, Suite 03-2303, Chicago, IL 60611, USA.
Northwestern University, Feinberg School of Medicine, Division of Minimally Invasive Gynecology, 250 E Superior, Suite 03-2303, Chicago, IL 60611, USA.
Best Pract Res Clin Obstet Gynaecol. 2018 Jan;46:99-112. doi: 10.1016/j.bpobgyn.2017.09.012. Epub 2017 Sep 29.
Laparoscopic myomectomy is a minimally invasive surgical approach to treat symptomatic uterine fibroids in women wishing for a uterine-sparing procedure. With careful patient selection, these procedures are associated with favorable reproductive outcomes and low perioperative morbidity. Current available methods for specimen retrieval include power and hand morcellation. The 2014 FDA safety warnings regarding power morcellation arose from concerns about the spread of occult malignancy and prompted widespread use of containment systems that may limit spread of myometrial cells. Investigation into the clinical effects of laparoscopic myomectomy and uncontained morcellation on the prognosis and spread of occult leiomyosarcoma has yielded mixed results. Other complications of uncontained power morcellation exist, including the development of parasitic leiomyomas. The FDA safety warnings have greatly influenced trends in benign gynecologic surgery, and survey data reflect trends in providers' opinions of these trends. In conclusion, recommendations for the current practice of laparoscopic myomectomy and morcellation are reviewed.
腹腔镜子宫肌瘤剔除术是一种微创外科手术方法，适用于希望保留子宫的有症状的子宫肌瘤妇女。通过仔细选择患者，这些手术与良好的生殖结局和低围手术期发病率相关。目前可用于标本取出的方法包括电动和手动切碎。2014 年 FDA 关于电动切碎的安全性警告是由于担心隐匿性恶性肿瘤的扩散，并促使广泛使用可能限制子宫细胞扩散的隔离系统。对腹腔镜子宫肌瘤剔除术和未隔离的切碎对隐匿性平滑肌肉瘤的预后和扩散的临床影响的研究结果喜忧参半。未隔离的电动切碎术还存在其他并发症，包括寄生性平滑肌瘤的形成。FDA 的安全警告极大地影响了良性妇科手术的趋势，调查数据反映了提供者对这些趋势的看法的趋势。总之，对目前腹腔镜子宫肌瘤剔除术和切碎术的实践提出了建议。
