Chang Chi-Han, Ding Dah-Ching
Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan.
Department of Obstetrics and Gynecology, College of Medicine, Tzu Chi University, Hualien, Taiwan.
Heliyon. 2024 Oct 18;10(20):e39550. doi: 10.1016/j.heliyon.2024.e39550. eCollection 2024 Oct 30.
Preserving the integrity of the endometrial cavity is crucial, particularly for preserving fertility during laparoscopic myomectomy (LM). This study aimed to compare the uterine breaching rate and clinical outcomes of LM performed with and without a uterine manipulator.
Data from women who underwent LM at our hospital between January 2020 and June 2023 were retrospectively analyzed. The primary outcomes included endometrial cavity breaching rate, conversion rate, abdominal port count, operative time, hospitalization duration, and blood loss. The secondary outcomes included adverse events such as postoperative anemia and emphysema.
We analyzed the data from 50 participants, comparing those with (n=30) and without (n=20) manipulators. No significant differences were observed in age, body mass index, surgical time, hospitalization, blood loss, or hemoglobin drop. However, the incidence of endometrial cavity breach was higher in the manipulator group (p=0.007). The manipulator group required fewer abdominal ports (p < 0.001) than the manipulator group. Increased myoma size was associated with increased blood loss and surgical time.
The clinical outcomes of LM without a uterine manipulator were comparable to those of LM with a manipulator. The absence of a manipulator may aid in preserving the integrity of the endometrial cavity. An increase in myoma size was associated with longer surgical time and greater blood loss, while uterine manipulator use was linked to fewer trocars.
保持子宫内膜腔的完整性至关重要，尤其是在腹腔镜子宫肌瘤切除术（LM）期间保留生育能力方面。本研究旨在比较使用和不使用子宫操纵器进行LM的子宫穿孔率和临床结局。
回顾性分析2020年1月至2023年6月在我院接受LM的女性的数据。主要结局包括子宫内膜腔穿孔率、中转率、腹部切口数量、手术时间、住院时间和失血量。次要结局包括术后贫血和肺气肿等不良事件。
我们分析了50名参与者的数据，比较了使用（n = 30）和未使用（n = 20）操纵器的两组。在年龄、体重指数、手术时间、住院时间、失血量或血红蛋白下降方面未观察到显著差异。然而，操纵器组的子宫内膜腔穿孔发生率更高（p = 0.007）。操纵器组所需的腹部切口比无操纵器组少（p < 0.001）。肌瘤大小增加与失血量和手术时间增加相关。
不使用子宫操纵器的LM临床结局与使用操纵器的LM相当。不使用操纵器可能有助于保持子宫内膜腔的完整性。肌瘤大小增加与手术时间延长和失血量增加相关，而使用子宫操纵器与较少的套管针相关。
