Successful pregnancy outcome after laparoscopic-assisted excision of a bizarre leiomyoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bizarre leiomyoma is a rare leiomyoma variant that requires a precise histopathological evaluation. Especially when diagnosed in a younger woman, this tumor leads to challenging treatment issues involving fertility preservation. Owing to the low incidence of bizarre leiomyoma, there is insufficient evidence to support myomectomy alone as an appropriate management option. Also, the impact of bizarre leiomyoma on fertility is not well known.</p> <p>Case presentation</p> <p>A 30-year-old Japanese woman who had never given birth was referred to us because of a uterine tumor with an unusual diagnostic image and was treated by a gasless laparoscopic-assisted excision with a wound retractor. Owing to an unclear margin between her uterine tumor and myometrium, a concomitant excision of adjacent myometrial tissue was required to achieve the maximum resection of her tumor. The histopathological diagnosis was bizarre leiomyoma. Seven months later, she conceived spontaneously and her pregnancy course was uneventful. At 37 weeks of gestation, an elective cesarean section was performed. Although a slight omental adhesion was noted at the postexcisional scar, her uterine wall structure was well preserved and a recurrence of bizarre leiomyoma was not noted.</p> <p>Conclusions</p> <p>A laparoscopic-assisted excision of bizarre leiomyoma is a feasible and minimally invasive conservative measure for a woman who wishes to preserve fertility.</p

Isobaric (gasless) laparoscopic uterine myomectomy. An overview

The aim of this review has been to assess the usefulness and effectiveness of isobaric (gasless) laparoscopic myomectomy using a subcutaneous abdominal wall lifting system, and to evaluate the advantages and disadvantages of this technique in comparison with the conventional laparoscopic myomectomy using pneumoperitoneum. Laparoscopy using CO2 is more frequently employed for small or medium-sized myomas. Furthermore, multiple myomectomies (>or=3 myomas per patient) are performed rarely. Gasless laparoscopy permits the removal of large intramural myomas overcoming the difficulties associated with laparoscopic myomectomy using pneumoperitoneum. It appears to offer several advantages over conventional laparoscopy, such as elimination of the adverse effects and potential risks associated with CO2 insufflation; use of conventional laparotomy instruments that facilitate several steps of the procedure; reduced operative times and costs. Indeed, this procedure associates the advantages of laparoscopy and minimal access surgery with those of using the laparotomic instruments that are more reliable for uterine closure. The only advantage of the laparoscopy with pneumoperitoneum is the tamponade effect generated by the gas on the small vessels, thus reducing intraoperative bleeding. Laparoscopic myomectomy using CO2 remains the preferred minimally invasive approach for small and medium-sized myomas and when the total number of myomas removed does not exceed 2 or 3. Gasless laparoscopic myomectomy could be mainly indicated for removal of large intramural myomas (>or=8 cm) and/or for multiple myomectomies (>or=3 myomas per patient). Anyhow, further controlled studies are needed to evaluate entirely their respective indications

Gasless laparoscopic myomectomy - Indications, surgical technique and advantages of a new procedure for removing uterine leiomyomas

OBJECTIVE: To evaluate the feasibility, safety and reliability of gasless laparoscopic myomectomy (GLM) using a new subcutaneous lifting system (Laparotenser, Lucini L & T, Milan, Italy) for removing subserosal and intramural leiomyomas. STUDY DESIGN: A total of 279 women with at least 1 symptomatic subserosal or intramural myoma measuring >30 mm underwent GLM between April 1997 and July 2001. All procedures were performed by the same surgeons using the same technique. RESULTS: GLM was successful in all 279 patients. The mean size of the myomas were 5.9 cm. Their average number per patient was 3.1. The mean operating time was 73 minutes. Forty-eight patients subsequently carried a pregnancy to term. No cases of uterine rupture during pregnancy or labor were observed. CONCLUSION: GLM is a feasible, reliable and safe procedure for removing intramural and subserosal myomas. It appears to offer several advantages over laparoscopy with pneumoperitoneum. In addition, the largest and multiple medium-sized myomas can be removed rapidly and safely

Gasless laparoscopic myomectomy - Indications, surgical technique and advantages of a new procedure for removing uterine leiomyomas

OBJECTIVE: To evaluate the feasibility, safety and reliability of gasless laparoscopic myomectomy (GLM) using a new subcutaneous lifting system (Laparotenser, Lucini L & T, Milan, Italy) for removing subserosal and intramural leiomyomas. STUDY DESIGN: A total of 279 women with at least 1 symptomatic subserosal or intramural myoma measuring >30 mm underwent GLM between April 1997 and July 2001. All procedures were performed by the same surgeons using the same technique. RESULTS: GLM was successful in all 279 patients. The mean size of the myomas were 5.9 cm. Their average number per patient was 3.1. The mean operating time was 73 minutes. Forty-eight patients subsequently carried a pregnancy to term. No cases of uterine rupture during pregnancy or labor were observed. CONCLUSION: GLM is a feasible, reliable and safe procedure for removing intramural and subserosal myomas. It appears to offer several advantages over laparoscopy with pneumoperitoneum. In addition, the largest and multiple medium-sized myomas can be removed rapidly and safely

Isobaric (gasless) laparoscopic myomectomy during pregnancy

We report on the first case of an isobaric (gasless) laparoscopic myomectomy during the second trimester of pregnancy. Our patient had acute abdominal pain that did not respond to medical management. The procedure was performed under spinal anesthesia with conscious sedation. The remainder of the pregnancy was unremarkable. We believe that Surgical management of uterine leiomyoma during pregnancy may be successfully performed in carefully selected patients. Laparotomy can be avoided, and pregnant patients can be managed safely by operative laparoscopy. With isobaric laparoscopy, the adverse effects and potential risks of CO, insufflation are eliminated. The procedure can be performed under loco-regional anesthesia. The uterine closure can be performed safely and quickly as in laparotomy. (c) 2005 AAGL. All rights reserved

Isobaric gasless laparoscopic myomectomy for removal of large uterine leiomyomas

Background: This study aimed to evaluate the feasibility and safety of isobaric laparoscopic removal of large myomas (>= 8 cm) using the Laparotenser, a subcutaneous abdominal wall-lifting system. Methods: A series of 63 consecutive patients with at least one large symptomatic subserosal or intramural uterine myoma (>= 8 cm) underwent an isobaric gasless laparoscopic myomectomy. Conventional laparotomy instruments were used. Results: The procedure was successfully completed for all 63 consecutive patients. The average size of the dominant myoma was 11 cm. The mean number of myomas removed from each patient was 3.6. The mean blood loss was 143 ml, and the mean operating time was 72 min. No intraoperative complication occurred. Conclusions: Gasless laparoscopic myomectomy for the removal of large myomas using the Laparotenser is feasible and safe. It offers several advantages over laparoscopy with pneumoperitoneum. Conclusions: Gasless laparoscopic myomectomy for the removal of large myomas using the Laparotenser is feasible and safe. It offers several advantages over laparoscopy with pneumoperitoneum

T cell migration requires ion and water influx to regulate actin polymerization

Migration of T cells is essential for their ability to mount immune responses. Chemokine-induced T cell migration requires WNK1, a kinase that regulates ion influx into the cell. However, it is not known why ion entry is necessary for T cell movement. Here we show that signaling from the chemokine receptor CCR7 leads to activation of WNK1 and its downstream pathway at the leading edge of migrating CD4+ T cells, resulting in ion influx and water entry by osmosis. We propose that WNK1-induced water entry is required to swell the membrane at the leading edge, generating space into which actin filaments can polymerize, thereby facilitating forward movement of the cell. Given the broad expression of WNK1 pathway proteins, our study suggests that ion and water influx are likely to be essential for migration in many cell types, including leukocytes and metastatic tumor cells.</p

T cell migration requires ion and water influx to regulate actin polymerization

Acknowledgements: We thank Erik Sahai and Michael Way for critical reading of this manuscript. We thank Rachel Edgar and John O’Neill for helpful discussions. We thank Miriam Llorian Sopena for help with analysis of RNA-seq data. We thank the Advanced Light Microscopy, Flow Cytometry and Biological Research Facilities of the Francis Crick Institute for microscopy, flow cytometry and for animal husbandry. We thank Chou-Long Huang, Dario Alessi and Sung-Sen Yang for mouse strains. We thank Rachel Toth for generation of plasmids, and the MRC Protein Phosphorylation Unit for antibodies. V.L.J.T. was supported by the Francis Crick Institute which receives its core funding from Cancer Research UK (CC2080), the UK Medical Research Council (CC2080), and the Wellcome Trust (CC2080), and by a grant from UKRI Biotechnology and Biological Sciences Research Council (BB/V0088757/1). This work was partly supported by the Francis Crick Institute through provision of access to the MRC Biomedical NMR Centre. L.L.d.B. was funded by an Imperial College London President’s PhD Scholarship. For the purpose of Open Access, the author has applied a CC-BY public copyright licence to any Author Accepted Manuscript version arising from this submission.AbstractMigration of T cells is essential for their ability to mount immune responses. Chemokine-induced T cell migration requires WNK1, a kinase that regulates ion influx into the cell. However, it is not known why ion entry is necessary for T cell movement. Here we show that signaling from the chemokine receptor CCR7 leads to activation of WNK1 and its downstream pathway at the leading edge of migrating CD4+ T cells, resulting in ion influx and water entry by osmosis. We propose that WNK1-induced water entry is required to swell the membrane at the leading edge, generating space into which actin filaments can polymerize, thereby facilitating forward movement of the cell. Given the broad expression of WNK1 pathway proteins, our study suggests that ion and water influx are likely to be essential for migration in many cell types, including leukocytes and metastatic tumor cells.</jats:p