Abstract
Objective
We aimed to introduce the clinical experience with a new surgical technique, single-port access laparoscopic fundusectomy, and a more efficient uterus-sparing surgical method for treating multiple fibroids in patients without a pregnancy plan.
Methods
We performed single-port access laparoscopic myomectomy in 228 patients and single-port access laparoscopic fundusectomy in 35 patients and compared the surgical outcomes.
Results
Significant differences in the surgical outcomes were observed between the two operating methods. Operating time was 150.71±24.5 minutes in the fundusectomy group than 172.13±61.30 minutes in the multiple myomectomy group (P-value 0.042). Estimated blood loss was lesser (198.29±90.53 mL) in the fundusectomy group than (314.04±344.56 mL) in the multiple myomectomy group (P-value 0.049).
Conclusion
This experience suggests that single-port access laparoscopic fundusectomy is more effective than single-port access laparoscopic myomectomy in terms of operating time and estimated blood loss.
Keywords: Fundusectomy, Myomectomy, Laparoscopy, Leiomyoma
Introduction
Myoma is the most common benign tumor in women, and its incidence is increasing, being reported in 80% of all women [1–3]. In patients who do not wish to become pregnant, hysterectomy is recommended for symptomatic myomas; however, if the patient wishes to preserve the uterus, laparoscopic myomectomy is widely performed [4,5]. With the development of minimally invasive laparoscopic surgery, the single-port laparoscopic technique has been widely attempted [6–8]. The single-port laparoscopic technique is performed through a single incision in the navel, providing cosmetic advantages and allowing for complete removal of myomas without leaving residual tissue, thereby reducing concerns about the potential development of uterine sarcoma after myomectomy [9–11].
However, in the case of multiple myomas, when performing surgery with such a laparoscopic surgical method, compared to hysterectomy, there is a greater amount of operative time and bleeding, so fundusectomy was performed as a more efficient surgical method, and a comparative analysis was conducted on the surgical outcomes with conventional laparoscopic myomectomy.
Materials and methods
1. Patients characteristics
This study included 263 patients who underwent single-port laparoscopic myomectomy in the Department of Obstetrics and Gynecology of this Yeonje Ilsin Hospital between January 2021 and September 2024. Fundusectomy was preferentially recommended in cases where patients had no desire for future pregnancy and presented with multiple fibroids (≥5), especially of the intramural type, coexisting adenomyosis, uterine size equivalent to ≥16 weeks of gestation, or a history of prior pelvic or abdominal surgery. If the patient declined fundusectomy despite meeting these criteria, a conventional myomectomy was performed. This study was approved by the Institutional Review Board of the hospital, and all surgeries were performed by two surgeons. Patient information was collected through admission, outpatient, and surgical records and was analyzed retrospectively, including the patient’s age, body mass index, parity, number of previous surgeries, location of the myoma, weight of the removed myoma, number of removed myomas, maximum size of the removed myoma, type of concurrent surgeries such as ovarian surgery; operation time; degree of adhesion; blood loss during surgery; changes in hemoglobin before and after surgery; changes in hematocrit before and after surgery; presence of transfusion; presence of complications; duration of hospital stay after surgery; changes in uterine size at 1, 3, and 6 months and 1 year and 2 years after surgery; and recurrence of myoma. The operation time was defined as the time from the start of the incision in the umbilicus to the end of skin closure, and changes in hemoglobin and hematocrit levels before and after surgery were defined by the values determined at the last check before surgery and the first check after surgery. The amount of bleeding during surgery was calculated as the difference between the total suction amount and the irrigation amount, as recorded by the anesthesiologist and assistant. Complications were defined as additional treatments required due to surgery, including fever lasting >5 days, issues with the genitourinary system, organ injury, intra-abdominal hematoma, transfusion, and reoperation. The duration of hospital stay after surgery was typically within 7 days and was classified into 8–10 days, 11–14 days, and >15 days, depending on the presence of complications and patient symptoms.
2. Surgical method
All patients received prophylactic antibiotics 30 minutes before the start of surgery and after general preparation for surgery. General anesthesia was induced in the lithotomy position, and after cervical dilation, a uterine manipulator (Koh Colpotomizer, Colpo-Pneumo Occluder, RUMI; Cooper Surgical, Trumbull, CT, USA) was inserted. The single-port laparoscopic technique approach involved a 2–2.5 cm vertical incision on the umbilicus, reaching the fascial layer, and after con- firming the presence of adhesion, the EASY-One Port (C-BAVA; BJ, Co., Ltd., Daegu, Korea) was inserted to maintain the single-port laparoscopic technique port. After inserting carbon dioxide gas at 12 mmHg into the abdomen, a 5 mm, 35 cm laparoscope (Telescope; Karl Storz, Tuttlingen, Germany) was inserted to explore the location and number of myomas. Complete removal is the principal treatment for myomas larger than 2 cm. Grasping instruments were primarily straight instruments, 43 cm in length, similar to general laparoscopes. However, depending on the case, some instruments that allowed bending were also used. Before removing the myoma, 20 IU of vasopressin diluted in normal saline at a 1:80 ratio was injected into the myoma periphery, and monopolar and bipolar electrocauteries were used to remove the myoma. After myoma removal, the method of closure was continuous suturing with a 2-layer suture. In cases of fundusectomy, the remaining endometrium was sutured with a 1-layer continuous suture, and then the myometrial and serosal layers were sutured again with a 2-layer suture. The suture material used was monosin 1-0. Myomas smaller than 2 cm were removed without excision through the umbilical single port and myomas larger than 2 cm were removed using a scalpel through the umbilicus. A power morcellator (Electrical Morcellator; Gynecare, Somerville, NJ, USA) was not used due to concerns regarding the possibility of myoma tissue fragmentation. After myoma removal, a drainage tube was inserted through the abdominal incision and, if necessary, the uterotonic agent carbetocin (Duratocin inj. [Ferring Pharmaceuticals, Saint-Prex, Switzerland] 100 ug/1 mL) was used after surgery.
3. Statistical analysis
Statistical analyses were performed using SPSS ver 18.0 (SPSS Inc., Chicago, IL, USA), and Student’s t-test, Mann-Whitney U-test, and chi-square tests were used, with a P-value of <0.05 as statistically significant.
Results
The average age of the total 263 patients was 41.91±6.39 years (Table 1). The average body mass index was 23.12±3.74 and 57 patients (21.7%) had a history of surgery, with each surgery being 11 patients (4.2%) for one-time cesarean section, four patients (1.5%) for two or more cesarean sections, 17 patients (6.5%) for previous myomectomy, nine patients (3.4%) for adnexal surgery, seven patients (2.7%) for appendectomy, one patient for diagnostic laparoscope surgery, and three patients for other abdominal surgeries. The location of the myoma was intramural in 162 patients (61.6%), subserosal in 18 patients (6.8%), and submucosal in seven patients (2.7%); however, 76 patients (28.9%) had both submucosal and intramural myomas. The indications for surgery were excessive menstrual volume in 73 patients (27.8%), severe dysmenorrhea in 32 patients (12.2%), increase in the size of the myoma in 26 patients (9.9%), pelvic pain in 15 patients (5.7%), frequent urination in 29 patients (11.0%), concurrent ovarian tumor in six patients (2.2%), large palpable masses in the abdomen in 34 patients (12.9%), and asymptomatic myoma in 48 patients (18.3%). In cases of asymptomatic myoma, surgery was decided based on the patient’s request for reasons such as size >6 cm and cancer phobia.
Table 1.
Clinical characteristics of 263 patients
| Characteristic | Value |
|---|---|
| Age (yr) | 41.91±6.39 |
| BMI (kg/m2) | 23.12±3.74 |
| Previous abdominal operative history | 57 (21.7) |
| Number of previous abdominal operative history | 0.24±0.65 |
| Previous operation type | |
| C/Sec | 11 (4.2) |
| Twice or more C/Sec | 4 (1.5) |
| Myomectomy | 17 (6.5) |
| Adenxa operation | 9 (3.4) |
| Appendectomy | 7 (2.7) |
| Diagnostic laparoscopy | 1 (0.4) |
| Cholecystectomy | 3 (1.1) |
| Other abdominal surgery | 2 (0.8) |
| Number of myoma | 10.59±8.07 |
| Largest size of myoma (cm) | 9.01±3.53 |
| Huge myoma (>10 cm) | 115 (43.7) |
| Myoma type | |
| Intramural | 162 (61.6) |
| Subserosal | 18 (6.8) |
| Submucosal | 7 (2.7) |
| Combined | 76 (28.9) |
| Operative indication | |
| Menorrhagia | 73 (27.8) |
| Dysmenorrhea | 32 (12.2) |
| Enlarged size | 26 (9.9) |
| Pelvic pain | 15 (5.7) |
| Urinary frequency | 29 (11.0) |
| Combined ovarian mass | 6 (2.2) |
| Palpable abdominal huge mass | 34 (12.9) |
| Incidental myoma | 48 (18.3) |
Values are presented as mean±standard deviation or number (%).
BMI, body mass index.
During surgery, psoterior cul de sac obliteration was accompanied by deep infiltrative endometriosis in 19 patients (7.2%) and severe adhesions after the previous surgery were found in six patients (2.3%).
No cases of conversion to the multiport laparoscopic technique was noted during surgery; 12 patients were converted to open surgery.
Fundusectomy was performed on 35 patients, with an average age of 44.74±5.43 years, mainly in the age group of 40–49 years (74.3%), and cases with ≥10 myomas expected were 20 patients (57.1%), and cases with a history of surgery were 15 patients (42.9%) (Table 2). In cases of cervical myoma, one patient (2.9%) was treated, and concurrent endometriosis was suspected in 13 patients (37.1%). Myomectomy was performed on 228 patients, with an average age of 40.44±6.34 years, mainly in the age groups of 30–39 years (43.9%) and 40–49 years (44.7%), and cases with <10 myomas expected were 136 patients (59.7%), and cases with a history of surgery were 42 patients (18.4%), and concurrent endometriosis was suspected in 74 patients (32.5%). Therefore, fundusectomies were mainly performed in patients over 40 years of age, where the need for childbirth was low. In cases where multiple myomas were expected, or a history of surgery was present, more fundusectomies were performed.
Table 2.
Clinical characteristics of patients according by single port laparoscopic fundusectomy vs. myomectomy
| Clinical outcome | Fundusectomy | Myomectomy | P-value |
|---|---|---|---|
| No of patients | 35 | 228 | |
| Age (yr) | 44.74±5.43 | 40.44±6.34 | 0.00 |
| 20–29 | 1 (2.9) | 8 (3.5) | |
| 30–39 | 2 (5.7) | 100 (43.9) | |
| 40–49 | 26 (74.3) | 102 (44.7) | |
| 50–59 | 6 (17.1) | 17 (7.5) | |
| >60 | 0 (0.0) | 1 (0.4) | |
| Number predicted of myoma | |||
| <5 | 0 (0.0) | 72 (31.6) | |
| 5–9 | 15 (42.9) | 64 (28.1) | |
| 10–14 | 6 (17.1) | 52 (22.8) | |
| 15–19 | 8 (22.9) | 23 (10.1) | |
| >20 | 6 (17.1) | 17 (7.4) | |
| Size of myoma (cm) | 6.45±2.67 | 9.40±3.48 | 0.00 |
| Previous abdominal operative history | 15 (42.9) | 42 (18.4) | |
| Number of previous abdominal operative history | 0.54±0.71 | 0.20±0.46 | 0.00 |
| Previous operation type | |||
| C/Sec | 2 (5.7) | 9 (3.9) | |
| Twice or more C/Sec | 2 (5.7) | 2 (0.9) | |
| Myomectomy | 7 (20.0) | 10 (4.4) | |
| Adenxa operation | 2 (5.7) | 7 (3.1) | |
| Appendectomy | 0 (0.0) | 7 (3.1) | |
| Diagnostic laparoscopy | 0 (0.0) | 1 (0.4) | |
| Cholecystectomy | 1 (2.9) | 2 (0.9) | |
| Other abdominal surgery | 1 (2.9) | 1 (0.4) | |
| Myoma type | |||
| Intramural | 28 (80.0) | 134 (58.8) | |
| Subserosal | 1 (2.9) | 17 (7.5) | |
| Submucosal | 0 (0.0) | 7 (3.1) | |
| Combined | 6 (17.1) | 67 (29.4) | |
| Combined with endometriosis | 13 (37.1) | 74 (32.5) | 0.585 |
Values are presented as mean±standard deviation or number (%).
The average number of myomas removed was 10.59±8.07, ranging 1–50, excluding myomas <1 cm. The size of myomas was determined by the largest size on preoperative examination, with the largest size being 21 cm, the average size being 9.01±3.53 cm, the largest weight being 1,350 g, and the average weight being 331.10±233.35 g.
The results according to the surgical methods of fundusectomy and myomectomy were as follows (Table 3).
Table 3.
Comparison of factors affected by operating method
| Clinical outcome | Fundusectomy | Myomectomy | P-value |
|---|---|---|---|
| Number of myoma resected by myomectomy | 16.06±11.99 | 9.75±6.96 | 0.00 |
| Size of myoma (cm) | 6.45±2.67 | 9.40±3.48 | 0.00 |
| Weight of myoma (g) | 267.80±186.18 | 342.41±239.45 | 0.08 |
| Huge myoma (>10 cm) | 4 (11.4) | 111 (48.7) | 0.00 |
| Operation time (minutes) | 150.71±24.52 | 172.13±61.30 | 0.42 |
| Estimated blood loss (mL) | 198.29±90.53 | 314.04±344.56 | 0.49 |
| Change in hemoglobin (g/dL) | 1.69±0.68 | 2.27±1.50 | 0.02 |
| Change in hematocrit (%) | 5.13±2.18 | 6.77±4.07 | 0.02 |
| Complication | |||
| Transfusion | 4 (11.4) | 24 (10.5) | |
| Bladder injury | 0 (0.0) | 1 (0.4) | |
| Bowel injury | 0 (0.0) | 0 (0.0) | |
| Postoperative fever | 0 (0.0) | 0 (0.0) | |
| Intraperitoneal hematoma | 0 (0.0) | 1 (0.4) | |
| Reoperation | 0 (0.0) | 0 (0.0) | |
| Change operative method | 0 (0.0) | 1 (0.0) | |
| Postoperative hospital stay (days) | |||
| <7 | 35 (100.0) | 226 (99.1) | |
| 8–10 | 0 (0.0) | 2 (0.9) | |
| 11–14 | 0 (0.0) | 0 (0.0) | |
| >15 | 0 (0.0) | 0 (0.0) | |
Values are presented as mean±standard deviation or number (%).
In fundusectomy, the average number of myomas was 16.06±11.99, the average weight of myomas was 267.80± 31.47 g, the average largest size was 6.45±2.67 cm, and there were four cases (11.4%) of myomas exceeding 10 cm in size. In myomectomy, the average number of myomas was 9.75±6.96, the average weight of myomas was 342.41± 23.94 g, the average largest size was 9.40±3.48 cm, and huge myomas were found in 111 cases (48.7%). In all patients, the myomas were removed without using a power morcellator and were excised using a scalpel through a single port. In cases where a large number of fragments were expected due to the transformation of myomas, the myomas were removed by in-bag scalpel morcellation.
In fundusectomy, the average operation time was 150.71± 24.52 minutes, estimated blood loss was 198.29±90.53 mL, and in myomectomy, the average operation time was 172.13±61.30 minutes, estimated blood loss was 314.04± 344.56 mL, showing shorter operation time and less estimated blood loss in fundusectomy. The correlation between operation time and estimated blood loss was significant, with a Pearson correlation coefficient of 0.706 and a Spearman correlation coefficient of 0.674 (Fig. 1).
Fig. 1.
Comparison of operation time and estimated blood loss (EBL) by single-port laparoscopic fundusectomy vs. myomectomy. Op, operation.
The changes in hemoglobin before and after fundusectomy were 1.69±0.68 g/dL and the changes in hematocrit were 5.13±2.18%. In the case of myomectomy, the changes in hemoglobin were 2.27±1.50 g/dL and the changes in hematocrit were 6.77±4.07%. Four patients (11.4%) in the fundusectomy group and 24 (10.5%) in the myomectomy group required transfusion before and after surgery. Intra-abdominal hemorrhage after surgery occurred in one patient (0.4%) in the myomectomy group; however, no cases led to reoperation. Most patients had a typical postoperative hospital stay of 7 days.
During the 2-year follow-up after surgery, uterine size and cancer antigen 125 (CA125) levels were monitored, and no changes were observed in uterine size or swelling. In the case of myomectomy, slight changes were noted, but it was difficult to attribute any significant meaning to them. No significant changes were observed in CA125 levels in either group (Table 4).
Table 4.
Comparison of postoperative states according by single port laparoscopic fundusectomy vs. myomectomy
| Clinical outcome | Fundusectomy | Myomectomy | P-value |
|---|---|---|---|
| Preoperative largest size of uterus (cm) | 10.83±2.23 | 11.09±2.89 | 0.61 |
| Volume of uterus (g) | 491.46±354.11 | 496.76±429.56 | 0.94 |
| Postoperative largest size of uterus (cm) | |||
| 1 month later | 7.67±1.15 | 8.38±1.30 | 0.026 |
| 3 months later | 7.57±0.80 | 8.82±9.05 | 0.63 |
| 6 months later | 7.47±0.89 | 7.79±1.09 | 0.25 |
| 12 months later | 7.35±1.11 | 7.95±1.29 | 0.07 |
| 24 months later | 7.47±1.25 | 8.43±1.19 | 0.09 |
| Postoperative largest volume of uterus (g) | |||
| 1 month later | 123.04±72.02 | 143.34±79.68 | 0.19 |
| 3 months later | 110.04±61.8 | 121.66±60.48 | 0.52 |
| 6 months later | 105.90±45.27 | 105.90±45.27 | 0.59 |
| 12 months later | 98.55±77.74 | 114.71±61.30 | 0.32 |
| 24 months later | 91.50±66.30 | 137.49±80.88 | 0.22 |
| Preoperative CA125 (U/mL) | 20.73±10.0 | 30.14±45.94 | 0.229 |
| Postoperative CA125 (U/mL) | |||
| 1 month later | 25.55±18.83 | 27.28±35.19 | 0.88 |
| 3 months later | 9.98±2.76 | 16.53±15.00 | 0.29 |
| 6 months later | 11.67±3.2 | 13.21±7.05 | 0.42 |
| 12 months later | 11.18±5.14 | 15.29±15.20 | 0.26 |
| 24 months later | 14.39±5.34 | 14.31±6.74 | 0.98 |
| Reoperation | |||
| Hysterectomy | 0 (0.0) | 0 (0.0) | |
| Myomectomy | 0 (0.0) | 0 (0.0) | |
| Fundusectomy | 0 (0.0) | 0 (0.0) | |
| Long term complication | 0 (0.0) | 2 (0.9) | |
Values are presented as mean±standard deviation or number (%).
CA125, cancer antigen 125.
Discussion
Since the introduction of laparoscopy in 1987, most surgeries for myoma have been performed using a laparoscope. Laparoscopic surgery is known for its advantages, including reduced postoperative pain, shorter hospital stay and recovery period, lower adhesion occurrence, similar surgical outcomes, and fewer large scars [7–9]. Recently, the advantages of minimally invasive surgery have been further enhanced and single-incision laparoscopic surgery (laparoendoscopic single-site surgery, single-port access, and single incision laparoscopic surgery) has been introduced as a highly effective procedure that minimizes scarring [12]. Since the first single-port laparoscopic appendectomy was performed in 2005, it has been widely used in various clinical settings [13]. Although the single-port laparoscopic technique has become popular, in cases of large myoma resection, the operation time and blood loss increase, making it challenging [14].
Various methods, such as uterine artery ligation, uterine artery bipolar coagulation, or banding of the lower uterine segment, are known. Additionally, methods that remove only large myomas and leave smaller myomas intact have also been introduced. These methods have been reported to help remove large myomas with less blood loss and lower recurrence rates [15–17]. However, these methods do not reduce the operation time, and the difficulty of the surgery tends to increase. Fundusectomy is considered a new surgical method that reduces operation time and blood loss [18]. In case of large myomas, myomectomy after uterine artery ligation is generally recommended for women who want to preserve fertility, whereas hysterectomy is recommended for those who do not wish to preserve fertility. Fundusectomy is considered an effective surgical method for women who wish to preserve their uterus but have no pregnancy plans. For women, the uterus is not only a target for fertility but also a significant organ for their identity. It is widely known that depression is significantly observed in women after hysterectomy, which affects their quality of life. Studies have indicated that the psychological demands of uterine preservation are significant [19,20].
Fundusectomy is considered an effective surgical method in women who do not want fertility but want uterine preservation. The term fundusectomy refers to the removal of only the upper part of the stomach during stomach surgery; however, from a gynecological perspective, fundusectomy is considered a more appropriate expression.
Fundusectomy is a surgical method that simultaneously removes a developing myoma located at the fundus of the uterus and myomas that occur in the body and lower segment of the uterus using the existing myoma resection method. This approach reduces operation time and minimizes blood loss (Fig. 2). In particular, fundusectomy is considered an appropriate surgical method when the uterus is large or there is coexisting adenomyosis, or when there is a submucosal myoma in the uterus, reducing the incision on the uterus during surgery, using sutures, and minimizing blood loss by cutting off the ascending branch of the uterine artery during surgery. Moreover, in cases where pelvic endometriosis coexists, reducing uterine size by removing the myoma and part of the uterus is useful for confirming the surgical field. It is thought to increase the effectiveness of the surgery when adhesion detachment surgery or deep infiltrative pelvic endometriosis surgery must be performed simultaneously.
Fig. 2.
Preoperative and postoperative state in single-port laparoscopic fundusectomy (A-E). (A) Preoperative pelvic CT (sagittal view). (B) Multiple myoma (preoperative). (C) Wedge-shaped excision of the uterine fundus. (D) Closure of the endometrium. (E) Double-layer myometrial suturing. CT, computed tomography.
In the original research results, the average size of uterine myomas was 6.45±2.67 cm in fundusectomy, and 9.40±3.48 cm in myomectomy, with the size of uterine myomas being significantly larger in myomectomy, which was judged to be due to the relatively higher number of subserosal types in cases of large myomas which are generally easier to excise compared with intramural or fundal myomas. The number of myomas removed was an average of 16.06±11.99 in uterine fundusectomy, and 9.75±6.96 in myomectomy, with more uterine myomas removed in fundusectomy; however, the average operation time in fundusectomy was 150.71±24.52 minutes, and estimated blood loss was 198.29±90.53 mL, whereas the average operation time in myomectomy was 172.13±61.30 minutes, and estimated blood loss was 314.04±344.56 mL, showing shorter operation time and estimated blood loss in fundusectomy. The postoperative hemoglobin decrease was an average of 1.69±0.68 g/dL in fundusectomy and 2.27±1.50 g/dL in myomectomy, with a less pronounced postoperative hemoglobin decrease observed.
The method of performing fundusectomy is as follows (Fig. 3).
Fig. 3.
Operating procedures in single-port laparoscopic fundusectomy (A-D). (A) Multiple myoma (preoperative). (B) Wedge-shaped excision of the uterine fundus. (C) Closure of the endometrium. (D) Double-layer myometrial suturing.
The upper part of the uterus was removed using monopolar cautery or an energy device. At this time, the excision is performed in a wedge shape so that a flap that can cover the upper part of the remaining uterine body and the insertion area of the salpinx on both sides of the uterus is not left. The remaining endometrium was continuously sutured using monosin 1-0, and the remaining myometrium of the uterine body was folded using the double-flap method and continuously sutured. The suture is performed using an in-out or out-in method, which is not related to the surgical outcome; when the flap is sufficiently folded and sutured, this part is tightly held in the shape of the uterine fundus. At this time, the endometrium is continuously sutured, and the upper-remaining myometrium is sutured once more to adopt a two-layer suture method, which can reduce the risk of uterine perforation during subsequent procedures, such as dilation and curettage (D&C). It is thought to prevent the occurrence of adenomyosis.
Even in ultrasound examinations after fundusectomy, the shape of the uterus was well maintained, and symptoms such as menstrual volume and dysmenorrhea were observed to decrease. No cases of uterine enlargement or worsening of clinical symptoms were observed during the 2-year follow-up period and no other complications related to the surgery were noted (Fig. 4). During the 24-month follow-up period, no patient showed an increase in uterine size or progressive enlargement. A small number of patients experienced fibroid or adenomyosis recurrence; however, no patient required reoperation within 2 years of surgery. Intraoperatively, no significant technical differences were observed between the fundusectomy and myomectomy groups. However, after fundusectomy, the fundal wall of the uterus may remain relatively thin. Therefore, during subsequent intrauterine procedures, such as D&C or hysteroscopy, the risk of uterine perforation is considerably increased and should be carefully considered in clinical practice.
Fig. 4.
Postoperative ultrasound image of uterus in patients who underwent single-port laparoscopic fundusectomy. (A) preoperative, (B) after 1 Mo, (C) after 3 Mo, (D) after 6 Mo, (E) after 12 Mo, (F) after 24 Mo. Mo, months.
Fundusectomy is a very useful surgical method for women with developing myomas who do not wish to become pregnant and wish to preserve the uterus, especially when there is coexisting adenomyosis, when the uterus is large, or when there is coexisting submucosal myoma, to reduce the operation time and intraoperative blood loss. However, one limitation of this study was the inherent selection bias, as fundusectomy was generally performed in cases anticipated to be technically more challenging than conventional myomectomy.
Fundusectomy should be regarded as a limited surgical option, specifically for women who do not desire future pregnancy. More useful results can be obtained in a prospective study under the same conditions as those of an experienced surgeon. It is thought that research on pregnancy success and maintenance when the fundus of the uterus is reconstructed using a sufficient flap after fundusectomy, as well as the quality of life and psychological health, is necessary.
Funding Statement
This work was supported by a 2-year Research Grant of Pusan National University.
Footnotes
Conflict of interest
The authors declare no conflicts of interest related to this manuscript.
Ethical approval
This study received IRB approval, and the requirement for informed consent was waived owing to the retrospective nature of the study (IRB No. YJISH 24-20008).
Patient consent
Informed consent was waived due to the retrospective design of the study.
Funding information
This work was supported by a 2-year Research Grant of Pusan National University.
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