Background
Fibroids are common benign tumours arising in the uterus. Myomectomy is the surgical treatment of choice for women with symptomatic fibroids who prefer or want uterine conservation. Myomectomy can be performed by conventional laparotomy, by mini-laparotomy or by minimal access techniques such as hysteroscopy and laparoscopy.

Objectives
To determine the benefits and harms of laparoscopic or hysteroscopic myomectomy compared with open myomectomy.

Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (inception to July 2014), the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register of Controlled Trials (inception to July 2014), MEDLINE(R) (inception to July 2014), EMBASE (inception to July 2014), PsycINFO (inception to July 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (inception to July 2014) to identify relevant randomised controlled trials (RCTs). We also searched trial registers and references from selected relevant trials and review articles. We applied no language restriction in these searches.

Selection criteria
All published and unpublished randomised controlled trials comparing myomectomy via laparotomy, mini-laparotomy or laparoscopically assisted mini-laparotomy versus laparoscopy or hysteroscopy in premenopausal women with uterine fibroids diagnosed by clinical and ultrasound examination were included in the meta-analysis.

Data collection and analysis
We conducted study selection and extracted data in duplicate. Primary outcomes were postoperative pain, reported in six studies, and in-hospital adverse events, reported in eight studies. Secondary outcomes included length of hospital stay, reported in four studies, operating time, reported in eight studies and recurrence of fibroids, reported in three studies. Each of the other secondary outcomes—improvement in menstrual symptoms, change in quality of life, repeat myomectomy and hysterectomy at a later date—was reported in a single study. Odds ratios (ORs), mean differences (MDs) and 95% confidence intervals (CIs) were calculated and data combined using the fixed-effect model. The quality of evidence was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methods.

Main results
We found 23 potentially relevant trials, of which nine were eligible for inclusion in this review. The nine trials included in our meta-analysis had a total of 808 women. The overall risk of bias of included studies was low, as most studies properly reported their methods.

Postoperative pain: Postoperative pain was measured on a visual analogue scale (VAS), with zero meaning 'no pain at all' and 10 signifying 'pain as bad as it could be.' Postoperative pain was significantly less, as determined by subjectively assessed pain score at six hours (MD -2.40, 95% CI -2.88 to -1.92, one study, 148 women, moderate-quality evidence) and 48 hours postoperatively (MD -1.90, 95% CI -2.80 to -1.00, two studies, 80 women, I² = 0%, moderate-quality evidence) in the laparoscopic myomectomy group compared with the open myomectomy group. This means that among women undergoing laparoscopic myomectomy, mean pain score at six hours and 48 hours would be likely to range from about three points lower to one point lower on a VAS zero-to-10 scale. No significant difference in postoperative pain score was noted between the laparoscopic and open myomectomy groups at 24 hours (MD -0.29, 95% CI -0.7 to 0.12, four studies, 232 women, I² = 43%, moderate-quality evidence). The overall quality of these findings is moderate; therefore further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

In-hospital adverse events: No evidence suggested a difference in unscheduled return to theatre (OR 3.04, 95% CI 0.12 to 75.86, two studies, 188 women, I² = 0%, low-quality evidence) and laparoconversion (OR 1.11, 95% CI 0.44 to 2.83, eight studies, 756 women, I² = 53%, moderate-quality evidence) when open myomectomy was compared with laparoscopic myomectomy. Only one study including 148 women reported injury to pelvic organs (no events were described in other studies), and no significant difference was noted between laparoscopic myomectomy and laparoscopically assisted mini-laparotomy myomectomy (OR 3.04, 95% CI 0.12 to 75.86). Significantly lower risk of postoperative fever was observed in the laparoscopic myomectomy group compared with groups treated with all types of open myomectomy (OR 0.44, 95% CI 0.26 to 0.77, I² = 0%, six studies, 635 women). This indicates that among women undergoing laparoscopic myomectomy, the risk of postoperative fever is 50% lower than among those treated with open surgery. No studies reported immediate hysterectomy, uterine rupture, thromboembolism or mortality. Six studies including 549 women reported haemoglobin drop, but these studies were not pooled because of extreme heterogeneity (I² = 97%) and therefore could not be included in the analysis.

Authors' conclusions
Laparoscopic myomectomy is a procedure associated with less subjectively reported postoperative pain, lower postoperative fever and shorter hospital stay compared with all types of open myomectomy. No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy. More studies are needed to assess rates of uterine rupture, occurrence of thromboembolism, need for repeat myomectomy and hysterectomy at a later stage.

Minimally invasive surgical techniques versus open myomectomy for uterine fibroids

Background Endometriosis is a chronic and progressive condition of women of reproductive age. It is strongly associated with significant impairment of sexual function. Aim To objectively evaluate the impact of laparoscopic excision of endometriosis on sexual function in patients with deep infiltrating endometriosis (DIE) compared to healthy women. Setting and design Prospective study, including 250 patients with a diagnosis of DIE scheduled for laparoscopic surgery and 250 healthy women. Methods A sexual activity questionnaire, SHOW-Q (Sexual Health Outcomes in Women Questionnaire), was used to collect data pertaining to women9s satisfaction, orgasm, desire and pelvic problem interference with sexual function. Women with DIE underwent complete excision of endometriotic lesions. All participants were asked to complete the SHOW-Q questionnaire before and after surgery. Results SHOW-Q scores in the endometriosis group before and 6 months after surgery were compared with the healthy group scores. A significant improvement was found between pre- and post-treatment in the scores of the satisfaction scale, desire scale and pelvic problem interference scale of SHOW-Q. The distribution of post-surgery SHOW-Q scores was comparable to healthy women9s scores apart from the orgasm scale score, which was unchanged in the post-surgery group. Conclusions The surgical approach to treatment has a positive impact not only on organ impairment but also on sexual function in women affected by DIE.

https://srh.bmj.com/content/familyplanning/41/4/278.full.pdf

Sexual function in women undergoing surgery for deep infiltrating endometriosis: a comparison with healthy women.

Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers.

Sonographic evaluation of deep endometriosis: protocol for a US radiology practice.

Endometriosis is a common chronic disease mostly seen in young women. Endometriosis surgery may be considered as rather challenging in gynecology. In this article, we tried to emphasize on basic concepts of endometriosis surgery, the best surgical method that should be applied and the complications and the management of the complications.

https://journals.sagepub.com/doi/pdf/10.2217/whe.15.55

Complications and Their Management in Endometriosis Surgery

Objectif : Evaluer le depistage et la prise en charge therapeutique des dysmenorrhees au cours d’une consultation de contraception par des medecins generalistes. Materiel et methodes : Nous avons realise une etude descriptive basee sur un questionnaire evaluant le depistage et le traitement des dysmenorrhees au cours d’une consultation de mise en place ou de renouvellement d’une contraception par les praticiens haut-normands. Le questionnaire a ete valide et envoye par l’Union Regionale des Professionnels de Sante (URPS) a 830 praticiens de Haute Normandie. Resultats : Parmi les 91 medecins generalistes inclus (MGI), plus de la moitie (54.9 %) differencient les dysmenorrhees des « douleurs de regles ». 42.9 % d’entre eux pensent que les douleurs abdominales sont un phenomene normal au cours des regles. Lors de l’interrogatoire en consultation de contraception, les douleurs abdominales pendant les regles ne sont recherchees que par ¾ des MGI tandis que d’autres signes tels que l’HTA, le tabac ou le diabete sont demandes de facon quasi systematique. 83.5 % des praticiens affirment evaluer l’importance des douleurs. Au niveau therapeutique, 20.9 % des MGI affirment que la presence de douleurs n’influence pas le choix de traitement contraceptif. Pour 93.4% des MGI, prescrire la pilule en continu n’est pas nefaste. En cas de dysmenorrhees, plus de la moitie des MGI (51.6 %) prescrivent la pilule en continu. En cas de decouverte de douleurs lors d’un renouvellement, ils sont 44% a choisir le schema en continu. Concernant la formation, 48.4 % des MGI ont recu une formation a l’endometriose. Ils sont 79.1 % a penser qu’une formation de ce type leur serait utile. Conclusion : Les dysmenorrhees sont insuffisamment prises en compte en consultation de medecine generale. La confusion par les praticiens entre dysmenorrhees et « douleurs de regles » est un frein a un depistage efficace. Par oubli ou minimisation des risques, ces douleurs ne font pas partie des elements cles d’un interrogatoire de contraception. De plus, les femmes en meconnaissent generalement la potentielle gravite. Le diagnostic et le traitement sont donc souvent inadaptes. Une formation appropriee des medecins, une information des patientes et la mise au point de recommandations de bonne pratique seraient benefiques.

https://dumas.ccsd.cnrs.fr/dumas-01235795/document

Évaluation et prise en charge des dysménorrhées lors d’une consultation de contraception par les médecins généralistes de Haute Normandie

Pain Control and Quality of Life after In-Block Resection of Deep Infiltrating Endometriosis vs. Incomplete Surgical Treatment with or without Medical Therapy

Surgical management of deep infiltrating endometriosis

Laparoscopic and abdominal myomectomy: Role on fertility and pregnancy outcome

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Papers

Pain Control and Quality of Life after In-Block Resection of Deep Infiltrating Endometriosis vs. Incomplete Surgical Treatment with or without Medical Therapy

Surgical management of deep infiltrating endometriosis

Laparoscopic and abdominal myomectomy: Role on fertility and pregnancy outcome