Clinical Edge Journal Scan

Clinical Edge Journal Scan Commentary: Uterine Fibroids December 2021

Dr. Christianson scans the journals, so you don’t have to!

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Mindy S. Christianson, M.D.

Relugolix, an oral GnRH antagonist, effectively reduces menstrual blood loss due to uterine fibroids, according to a recently published randomized controlled trial published in BMC Womens Health . The phase 2, multicenter, double-blind, parallel-group study was conducted at 36 sites in Japan in women with uterine fibroids and heavy menstrual bleeding, defined by a pictorial blood loss assessment chart (PBAC) score of ≥ 120 in one menstrual cycle. Overall, 216 premenopausal women were randomly assigned 1:1:1:1 to receive relugolix 10 mg, 20 mg, 30 mg, 40 mg, or placebo. The primary endpoint was the proportion of patients with a total PBAC score of < 10 from week 6 to 12. Between weeks 6 to 12, the proportion of patients with a PBAC score of less than 10 was higher in the relugolix 40 mg (difference vs placebo [ D], 83.3%), 20 mg ( D, 42.6%), and 10 mg ( D, 20.8%) treatment arms (all P < .001). Treatment-associated adverse events were mostly mild/moderate but were more frequent in relugolix arm (85.4%-96.4%%) versus placebo (70.2%).

A recent study by Lee et al in the Journal of Obstetrics and Gynaecology Research evaluated the feasibility of robotic single-port myomectomy (RSPM) using the da Vinci SP surgical system. In this prospective observational study, 61 women with symptomatic fibroids underwent RSPM. In women with less than 7 resected uterine fibroids (maximal diameter < 10 cm) as well as those with at least 7 resected fibroids ( maximal diameter of resected fibroids ≥10 cm), there was no conversion to single-port laparoscopic myomectomy, multiport laparoscopic myomectomy, or laparotomy. Reported complications were minor and included fever, transient ileus and blood transfusion in 15 patients. The authors proposed that robotic single-port myomectomy could solve many of the ergonomic problems associated with single-port laparoscopic myomectomy.

When performing myomectomy during C-section, is there a method that is advantageous? This question was evaluated by Karaca SY et al in European Journal of Obstetrics and Gynecology and Reproductive Biology who compared transendometrial myomectomy with conventional myomectomy. Overall, 41 patients underwent transendometrial myomectomy, and 52 patients underwent conventional myomectomy, with all patients having one single anterior intramural fibroid removed. The mean duration of surgery (50.5 minutes vs 63.6 minutes; P = .001) was lower in the transendometrial group versus the conventional myomectomy group. Additionally, p atients who underwent transendometrial myomectomy (0.58 ± 0.61) had significantly lower adhesion scores in their subsequent pregnancy compared to patients who underwent conventional myomectomy (1,76 ± 1,1) ( P = 0.001). Length of hospital stay, procedure-related hemoglobin difference, blood transfusion requirement, and postoperative fever were similar in both groups.

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