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With experience, the procedure can be undertaken with minimal complications, a low risk of conversion to laparotomy and early discharge from hospital, even in cases of large and multiple fibroids that historically would have required the open approach.
As expected, blood loss and operating time are directly related to fibroid size and number; however, large, multiple fibroids can be tackled safely without any increase in patient morbidity and length of hospital stay.
When comparing the number of fibroids removed and operative outcomes, there was a significantly greater blood loss and operating time in patients having multiple fibroids removed compared to those having a single myomectomy.
According to a randomized controlled trial (RCT) on the effectiveness of preoperative treatment before operative hysteroscopy, the incidence of postsurgical IUAs at second-look hysteroscopy is 3.6 % after polyp removal, 6.7 % after resection of uterine septa, 31.3 % after removal of a single fibroid, and 45.5 % after resection of multiple fibroids [3].
If the volume of the largest fibroid is measured, the reported volume is 11 cm; if total volume of multiple fibroids is measured, it is 18 cm; if average volume of multiple fibroids is measured, it is 6 cm.
Among the 21 trials, 13 trials reported average volume of maximum fibroids, two trials reported total volume of multiple fibroids, four trials reported average volume of multiple fibroids, and two trials reported average diameter of fibroids.
Similar(49)
Thirty-one percent of patients had a single fibroid removed, and the remaining 69% required multiple fibroid removal.
The lowest incidence of adhesion formation follows polypectomy with the highest rate of adhesion formation following multiple fibroid resection [45].
The primary endpoint analysis is performed on a per-fibroid basis, rather than using a subjective "dominant fibroid" in a given patient who could have multiple similar fibroids that were ablated.
Open myomectomy (OM) was preferred when a fibroid was larger than 8 cm, in the case of a finding of multiple intramural fibroids, and in the case of a very unfavorable localization of a fibroid (e.g., in uterine edges reaching the pelvic wall or deep in the posterior uterine wall reaching the insertions of sacro-uterine ligaments).
Ultrasonography revealed no abnormal masses except for multiple uterine fibroids.
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