pituitrin and Leiomyoma

To collate evidence from randomized controlled trials (RCTs) and nonrandomized controlled trials (NCTs) on the efficacy and safety of vasopressin versus passive control (placebo/no treatment) during myomectomy.. Six information sources were screened until 25-June-2022. The Cochrane Collaboration tool and Newcastle-Ottawa Scale were used to evaluate the risk of bias. Data were summarized as mean difference or risk ratio with 95% confidence interval in a random-effects model.. Eleven studies, comprising 1067 patients (vasopressin=567 and control=500) were analyzed. For RCTs (n = 8), the overall quality included 'high risk' (n = 4), 'low risk' (n = 2), and 'some concerns' (n = 2). For NCTs (n = 3), the overall quality included 'good' (n = 2) and 'fair' (n = 1). The mean intraoperative blood loss, mean difference in hemoglobin level, mean difference in hematocrit level, rate of perioperative blood transfusion, and mean operative time were significantly reduced in favor of the vasopressin group compared with the control group. However, there was no significant difference between both groups regarding the mean hospital stay. Pertaining to safety endpoints, after omission of an outlier study, the rate of drug-related cardiovascular adverse events did not significantly differ between both groups. There was no quantitative evidence of publication bias for the endpoint of intraoperative blood loss.. Among patients undergoing myomectomy, prophylactic administration of vasopressin was largely safe and correlated with significant reductions in intraoperative blood loss and associated morbidities compared with a passive control intervention. Nonetheless, the conclusions should be cautiously interpreted owing to the low-evidence quality and the used doses varied greatly between studies.

Topics: Blood Loss, Surgical; Female; Humans; Leiomyoma; Morbidity; Randomized Controlled Trials as Topic; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Open myomectomy is the most adopted surgical strategy in the conservative treatment of uterine fibroids. According to several studies, the likelihood that a woman could develop uterine myomas is estimated around 75% by the age of 50. Open myomectomy is nonetheless a complicated surgery in terms of blood loss and need for transfusion. Many strategies have been published with the aim of limiting intra and post-operative bleeding complications. The scope of this review is to describe in detail the different techniques reported in literature focusing on their validity and safety.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Ligation; Operative Blood Salvage; Oxytocics; Oxytocin; Tourniquets; Tranexamic Acid; Uterine Artery; Uterine Artery Embolization; Uterine Neoplasms; Vasopressins

Recent technological advances in endoscopy have allowed gynecological surgeons to expand the operative approaches that can be utilized in the conservative management of uterine myomas. Commonly used approaches in gynecological practice now include laparoscopic myomectomy, laparoscopic-assisted myomectomy through a mini-laparotomy incision and robotic-assisted laparoscopic myomectomy. Adequate preoperative evaluation with careful selection of the best operative approach for each particular patient constitutes the basis of safe and effective surgery for the operative management of uterine myomas.

Topics: Blood Loss, Surgical; Disease Management; Endoscopy; Female; Humans; Hysteroscopy; Laparoscopy; Laparotomy; Leiomyoma; Length of Stay; Minimally Invasive Surgical Procedures; Multicenter Studies as Topic; Preoperative Care; Randomized Controlled Trials as Topic; Retrospective Studies; Robotics; Surgery, Computer-Assisted; Sutures; Uterine Neoplasms; Vasopressins

To determine if higher-volume, fixed-dose administration of vasopressin further reduces blood loss at the time of minimally invasive myomectomy.. Randomised multicentre clinical trial.. Tertiary-care academic centres in the USA.. Women undergoing conventional laparoscopic or robot-assisted laparoscopic myomectomy.. All participants received the same 10-unit (U) dose of vasopressin, but were randomly assigned to one of two groups: (i) received 200 ml of diluted vasopressin solution (20 U in 400 ml normal saline), and (ii) received 30 ml of concentrated vasopressin solution (20 U in 60 ml normal saline).. The primary study outcome was estimated blood loss; the study was powered to detect a 100-ml difference.. A total of 152 women were randomised; 76 patients in each group. Baseline demographics were similar between groups. The primary outcome of intraoperative blood loss was not significantly different, as measured by three parameters: surgeon estimate (mean estimated blood loss 178 ± 265 ml and 198 ± 232 ml, dilute and concentrated groups respectively, P = 0.65), suction canister-calculated blood loss, or change in haematocrit levels. There were no vasopressin-related adverse events.. Both dilute and concentrated vasopressin solutions that use the same drug dosing demonstrate comparable safety and tolerability when administered for minimally invasive myomectomy; however, higher volume administration of vasopressin does not reduce blood loss.. This randomised trial failed to show benefit of high-volume dilute vasopression.

Topics: Adult; Blood Loss, Surgical; Female; Hemostasis, Surgical; Hemostatics; Humans; Laparoscopy; Leiomyoma; Middle Aged; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

To compare the effectiveness and safety of vasopressin with epinephrine for reducing blood loss during laparoscopic myomectomy.. Sixty patients undergoing laparoscopic myomectomy were allocated at random to receive either dilute vasopressin or epinephrine into the serosal and/or overlying myometrium, and just around the myoma. The surgeon was blinded to the group allocation. Blood loss, duration of surgery, degree of surgical difficulty, postoperative pain scores and complications were compared.. Patient characteristics (e.g. age, body mass index, demographic data), number of myomas, and location and size of the largest myoma were similar between the two study groups. There were no differences in operative blood loss, operative time, subjective surgical difficulty or postoperative pain between the two groups. Transient and non-serious increases in systolic and diastolic blood pressure and heart rate following intra-operative intramyometrial and/or perimyometrial injection of the vasoconstrictive agent only occurred in the epinephrine group, but the difference between the groups was not significant (13% vs 0%, p=0.112). No significant postoperative complications were observed in either group.. Injection of dilute epinephrine before laparoscopic myomectomy was comparable to injection of dilute vasopressin in terms of operative blood loss, operative time, subjective surgical difficulty, postoperative pain and complications.

Topics: Adult; Blood Loss, Surgical; Epinephrine; Female; Humans; Laparoscopy; Leiomyoma; Middle Aged; Neoplasms, Multiple Primary; Uterine Hemorrhage; Uterine Myomectomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To evaluate the efficacy of transcervical intralesional vasopressin injection to submucous myoma in hysteroscopic myomectomy from 2011 to 2014.. This was a prospective, randomized, double-blind study in a single center. Forty premenopausal women with symptomatic submucous myoma requiring hysteroscopic myomectomy were randomized to transcervical intralesional vasopressin injection or placebo in a 4:4 ratio. The primary outcome was operative time. Secondary outcomes including fluid volumes, blood loss, and visual clarity were compared between the two groups.. The median duration for myomectomy was 19.9 minutes (range 3.1-54.2 minutes) in the vasopressin group compared with 29.0 minutes (range 8.0-60.9 minutes) in the placebo group, a nonsignificant difference (P=.14). There were significant reductions in the median volume of fluid used (4,200 mL [range 1,300-21,000 mL] compared with 9,800 mL (range 1,500-23,000 mL; P=.004) and fluid intravasation (0 mL [range 0-3,100] compared with 300 mL [range -150-3,150 mL; P=.029) in the vasopressin group. The median intraoperative blood loss was reduced (5 mL [range 1-50 mL] compared with 20 mL [range 1-150 mL; P=.002). The operative surgeon rated that 95% of the vasopressin group had "minimal" bleeding compared with 36.8% in the placebo group. The surgical field (visual analog scale [VAS] 9 [range 2-10] compared with 6 [range 2-10; P<.001]; 0=worst visual clarity, 10=best visual clarity) and the effluent fluid (VAS 1 [range 0-7] compared with 4 [range 0-8; P<.001]; 0=clear, 10=unclear) were statistically significantly clearer in the vasopressin group.. Transcervical intralesional vasopressin injection in hysteroscopic myomectomy did not reduce operative time but did reduce volume of inflow fluid, fluid intravasation, intraoperative blood loss, and improving visual clarity.. Centre for Clinical Research and Biostatistics, http://www.cct.cuhk.edu.hk/Registry/publictriallist.aspx, CUHK_CCT00291.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Double-Blind Method; Female; Humans; Hysteroscopy; Injections, Intralesional; Leiomyoma; Middle Aged; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To compare the efficacy of rectal misoprostol plus perivascular vasopressin with perivascular vasopressin alone as hemostatic agents for the reduction of blood loss during myomectomies.. Prospective, randomized, double-blind, controlled study.. University of the West Indies and Andrews Memorial Hospital.. Fifty women with symptomatic uterine fibroids, 25 receiving misoprostol and vasopressin and 25 receiving vasopressin alone before myomectomy.. Abdominal myomectomies on patients with symptomatic uterine fibroids.. Perioperative blood loss and febrile morbidity.. There were no statistically significant differences in sociodemographic, clinical, or myoma characteristics between the two groups at baseline. Postoperatively, there were no statistically significant differences in perioperative febrile morbidity or blood pressure between the groups. However, the group treated with misoprostol plus vasopressin had statistically significantly lower blood loss (geometric mean with 95% confidence interval, 334 mL [261 to 428] vs. 623 mL [354 to 1,094], a smaller change in hemoglobin (1.6 ± 1.5 vs. 3.0 ± 2.0), and a lower requirement for transfusion. In addition to treatment, significant determinants of blood loss were larger size of fibroids and greater number of fibroids.. We conclude that perivascular vasopressin plus misoprostol caused a significant reduction in blood loss compared with perivascular vasopressin alone.. NCT01700478.

Topics: Administration, Rectal; Adult; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Drug Therapy, Combination; Female; Hemostatic Techniques; Hemostatics; Humans; Jamaica; Leiomyoma; Misoprostol; Prospective Studies; Time Factors; Treatment Outcome; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

To study the effects of reducing hemorrhage by loop ligation of larger myoma pseudocapsules combined with vasopressin on laparoscopic myomectomy (LM).. Prospective controlled clinical trial.. Sheng Jing Hospital, China Medical University.. A total of 105 women with symptomatic single or multiple larger myomas (diameter 6-18 cm) in need of surgical intervention, who wished to retain their uteri, were randomly divided into three groups in our hospital from January 2006 to January 2008: A) loop ligation combined with vasopressin; B) vasopressin alone; and C) neither loop ligation nor vasopressin. All patients were treated by LM. Each group included 35 cases.. Loop ligation of larger myoma (6-18 cm) pseudocapsule combined with vasopressin before thoroughly enucleating the myoma.. Operating time, blood loss, blood transfusion, postoperative stay in hospital, symptom improvement.. Average blood loss, postoperative stay in hospital, number of conversions to laparotomy, and need for transfusion because of bleeding during operation in group A were significantly lower than in groups B and C. All patients in group A underwent technically successful laparoscopic operations.. Loop ligation of larger myoma pseudocapsules combined with vasopressin is a safe, effective, and promising new method to reduce bleeding during laparoscopic myomectomy and makes the laparoscopic operations with larger myomas easier.

Topics: Adult; Chemotherapy, Adjuvant; Combined Modality Therapy; Female; Follow-Up Studies; Gynecologic Surgical Procedures; Humans; Laparoscopy; Leiomyoma; Ligation; Middle Aged; Tumor Burden; Uterine Artery; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins; Young Adult

To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy (LM).. Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups, Group A undergoing fibroid pedicle ligation, Group B injected with 12 IU diluted vasopressin around the myoma, Group C injected with 20 IU oxytocin combined with pedicle ligation, and Group D injected with vasopressin combined with pedicle ligation. The operation time, amount of blood loss, operative complications, bowel deflation, post-operative hemoglobin dropping, and length of hospital stay were compared.. The amounts of blood loss of Groups A and C were (171 +/- 146) ml and (184 +/- 140) ml, both significantly higher than those of Groups B and D [(115 +/- 70) ml and (106 +/- 73) ml, both P < 0.01]. The length of hospital stay of Group D was (2.9 +/- 0.5) d, significantly shorter than those of Groups A, B, and C [(3.1 +/- 0.7) d, (3.6 +/- 0.8) d, and (3.3 +/- 0.7) d, all P < 0.05]. The bowel deflation time of Group D was (20 +/- 6) h, significantly shorter than those of the Groups A, B, and C [(26 +/-) h, (25 +/- 7) h, and (25 +/- 8) h respectively, all P < 0.05]. The post-operative hemoglobin dropping of group D was (1.1 +/- 0.9) g/L, significantly less than those of Groups A, B, and C [(1.5 +/- 1.0), (1.4 +/- 0.8), and (1.2 +/- 0.7) g/L respectively, all P < 0.05].. Vasopressin (12 IU) injection around the myoma is a simple, effective, and safe homeostatic procedure during LM. Pedicle ligation can reduce advanced post-operative bleeding post-operation.

Topics: Adult; Combined Modality Therapy; Female; Gynecologic Surgical Procedures; Hemostatic Techniques; Hemostatics; Humans; Laparoscopy; Leiomyoma; Myoma; Oxytocics; Oxytocin; Postoperative Hemorrhage; Treatment Outcome; Uterine Neoplasms; Vasopressins

To investigate if the use of vasopressin during abdominal hysterectomy would decrease blood loss.. Fifty-one patients undergoing abdominal hysterectomy with the diagnosis of leiomyomatous uterus were randomized and received either vasopressin 10 units/10 mL of normal saline or 10 mL of normal saline, injected 5 mL bilaterally, 1 cm medial to the uterine vessels into the lower uterine segment. The sample size was determined assuming a one-third reduction in total blood loss would be clinically relevant. A power analysis determined that 25 patients would be required in each group to assure a power of 0.80, at the.05 significance level.. Overall, the two groups were very similar with regard to their demographics, preoperative diagnosis, and relevant findings at the time of surgery. The mean total blood loss in the vasopressin and placebo groups was 445.41 mL and 748.42 mL, respectively. Total blood loss was significantly decreased by 40% in the vasopressin group compared with the placebo group (P <.001). There was no statistically significant difference between the two groups with respect to possible confounding variables or surgical complications.. Injection of vasopressin into the uterus at the time of abdominal hysterectomy significantly reduces blood loss without increasing morbidity. We have shown that it is a useful adjunct during abdominal hysterectomy.

Topics: Adolescent; Adult; Blood Loss, Surgical; Female; Follow-Up Studies; Humans; Hysterectomy; Injections, Intralesional; Leiomyoma; Middle Aged; Probability; Reference Values; Sampling Studies; Treatment Outcome; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy.. Between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre- and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay.. Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] versus 512.7 mL [SD 400] for tourniquet [P = .036]). Six of 26 patients in the tourniquet group lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusions given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications.. Vasopressin prevents blood loss better than using the tourniquet during myomectomy.

Topics: Adult; Blood Loss, Surgical; Blood Pressure; Blood Transfusion; Female; Hemoglobins; Hemostasis, Surgical; Humans; Leiomyoma; Middle Aged; Postoperative Complications; Tourniquets; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Blood Loss, Surgical; Female; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

To assess the effect of intracervical injection of dilute (0.05 U/mL) vasopressin solution on blood loss during operative hysteroscopy.. In a randomized, double-blind study, dilute vasopressin solution or placebo (normal saline) was injected into the cervical stroma of 106 women before dilation of the cervix in preparation for operative hysteroscopy. Intraoperative bleeding was calculated by dividing the number of red blood cells per milliliter of outflow distention fluid by the number of red blood cells per milliliter of the woman's blood immediately before the procedure and multiplying this quotient by the total amount of outflow fluid collected. Pressures were kept constant with a hysteroscopic infusion pump.. The mean (+/-standard error of the mean) intraoperative blood loss of the treated (vasopressin) and control (placebo) groups was 20.3 +/- 4.1 mL (range 0-135) and 33.4 +/- 5.4 mL (range 0-290), respectively. The volume of distention fluid intravasation in the treated and control groups was 448.5 +/- 47.0 mL (range 30-1410) and 819.1 +/- 79.7 mL (range 20-1977), respectively. The operating time in the treated and control groups was 31.1 +/- 1.2 minutes (range 18-52) and 34.1 +/- 1.3 minutes (range 19-65), respectively. For all three outcome measures, the differences between the two groups were statistically significant, but for visual clarity of the uterine cavity during surgery, the difference was not significant.. Administration of dilute vasopressin solution (0.05 U/mL) to the cervical stroma significantly reduces blood loss, distention fluid intravasation, and operative time during hysteroscopy. Further evaluation is required to determine the optimum dosage.

Topics: Adult; Blood Loss, Surgical; Double-Blind Method; Endoscopy; Female; Hemodynamics; Hemostatics; Humans; Hysteroscopy; Leiomyoma; Middle Aged; Uterine Neoplasms; Uterus; Vasopressins

To assess the efficacy of intramyometrial vasopressin for minimising bleeding and its sequelae at myomectomy.. A randomised placebo controlled trial.. University Hospital of the West Indies, Kingston, Jamaica.. Twenty women with symptomatic uterine fibroids scheduled for myomectomy who satisfied entry criteria: 10 randomised to the vasopressin group and 10 to the control group.. Myomectomy was performed after the intramyometrial injection of either 20 units vasopressin diluted to 20 ml in normal saline or placebo (20 ml normal saline).. The efficacy of vasopressin was measured by comparing pre- and post-operative haemoglobin levels and haematocrit, changes in intra-operative pulse and blood pressure, measured blood loss, need for blood transfusion and post-operative febrile morbidity in the treatment and control groups.. The use of vasopressin resulted in median blood loss of 225 ml (range 150-400 ml) compared with 675 ml (range 500-800 ml) in the placebo group (P < 0.001). The vasopressin group had a correspondingly lower fall in haemoglobin level (median 1.7 g/dl vs 5.3 g/dl, P < 0.001) and haematocrit (median 5% vs 13%, P < 0.001) compared with the controls. Fifty percent of the placebo group had blood transfusions compared with none in the vasopressin group (P = 0.03). There were no significant differences between the groups in intra-operative pulse and blood pressure or post-operative white blood cell counts or temperature.. The results indicate that vasopressin is effective in preventing blood loss and reducing the need for blood transfusion during myomectomy.

Topics: Adult; Blood Loss, Surgical; Female; Hemoglobins; Hemostasis, Surgical; Humans; Injections; Leiomyoma; Pilot Projects; Uterine Neoplasms; Vasopressins

Vasopressin local infiltration is useful in gynecological surgery because it can reduce hemorrhage. Depending on the activities of the sympathetic system and the renin-angiotensin system, reactions to vasopressin may differ and predicting its systemic effects is difficult. Because life-threatening complications can occur, infiltration with vasopressin should be administered with caution. A 42-year-old female patient was diagnosed with uterine leiomyomas. During a robot-assisted laparoscopic myomectomy, 50 U of vasopressin, which is ten-times the recommended dose, was accidentally infiltrated. Subsequently, bradycardia with a heart rate of 25 bpm occurred, which recovered within 3 minutes. Peripheral perfusion indices and the diameter of the radial and brachial arteries also decreased markedly and recovered within 1 hour. The surgery was concluded without additional events. The patient was discharged 2 days later with no abnormal findings. Because vasopressin infiltration can cause life-threatening complications, it is necessary to determine the extent of patient reactions to vasopressin using measures such as the peripheral perfusion index or radial and brachial artery diameters. These measures may also help to predict the occurrence of complications.

Topics: Adult; Female; Gynecologic Surgical Procedures; Hemodynamics; Humans; Leiomyoma; Uterine Myomectomy; Vasopressins

Topics: Adult; Endometrial Ablation Techniques; Female; Humans; Leiomyoma; Middle Aged; Myoma; Uterine Neoplasms; Vasopressins

Vasopressin is a locally-injected vasoconstrictor used to reduce bleeding during gynaecological surgery. However, even in these cases, vasopressin can induce adverse effects, including bradycardia, myocardial infarction and cardiac arrest. Elevated blood concentrations of vasopressin may induce the sympathoinhibitory reflex by increasing blood pressure and augment the sympathoinhibitory reflex by activating the area postrema. In addition, pneumoperitoneum formation needed for laparoscopy as well as physiological changes caused by steep Trendelenburg positions used during robotic surgeries may cause bradycardia. Shoulder braces used to prevent slipping from a steep Trendelenburg position may also be hazardous. This case report describes a 31-year-old female patient who underwent a scheduled robotic-assisted laparoscopic myomectomy in a steep Trendelenburg position. The patient experienced a cardiac arrest 2 min after the vasopressin injection and was treated accordingly. There were no abnormal findings on the postoperative laboratory studies, chest X-ray and electrocardiogram. The patient also had clear consciousness with no other notable symptoms. The patient was discharged on postoperative day 2. The report discusses the potential adverse effects of local vasopressin injection during robotic-assisted laparoscopic myomectomy.

Topics: Adult; Female; Gynecologic Surgical Procedures; Heart Arrest; Humans; Injections, Intramuscular; Laparoscopy; Leiomyoma; Robotic Surgical Procedures; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Topics: Female; Humans; Laparoscopy; Leiomyoma; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Topics: Blood Loss, Surgical; Female; Humans; Laparoscopy; Leiomyoma; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

To demonstrate key steps in performing safe laparoscopic multiple myomectomy.. Video focuses on stepwise description of all major steps of the surgical technique.. Twenty-seven-year-old woman. Informed consent was taken from the subject, and the institutional review board approved this research.. Laparoscopic multiple myomectomy with morcellation in bag.. About one-third of women with fibroids present with symptoms severe enough to warrant treatment. We demonstrate a case of a 27-year-old woman with complaints of secondary infertility and menorrhagia. On examination the uterus was enlarged up to 24 weeks size. Ultrasonography mapping located 7 myomas ranging in size from of 3 to 10 cm and classified as International Federation of Gynecology and Obstetrics classes 2, 3, 4, 5, 6, and 7. Generally, laparotomy or laparoscopy and mini-laparotomy is performed for such cases of multiple myomas. However, the total laparoscopic approach can confer benefits if performed following safe steps and within good time. The following were the key steps of surgery: (1) Higher port position using Lee Huang point for primary port, (2) intermittent vasopressin use for each myomectomy, (3) cold technique of myomectomy, (4) myoma lace creation, (5) multiple layer suturing using double-ended barbed sutures, (6) myoma garland creation, and (7) morcellation in a stomach-shaped bag.. The intermittent use of vasopressin is effective in reducing blood loss. Suturing using barbed sutures is less time consuming. Creating lace of myomas by passing a thread through each myoma, prevents losing them in the abdominal cavity and creating garland of myomas by tying two free ends of the lace helps in easier bagging. Morcellation in bag prevents dissemination of bits of myoma and visceral injury. These steps help in performing laparoscopic multiple myomectomy safely. However, this technique should be reserved for selected cases and should be performed by surgical teams with the required expertise and experience.

Topics: Abdominal Cavity; Adult; Blood Loss, Surgical; Drug Administration Schedule; Female; Humans; Intraoperative Care; Laparoscopy; Leiomyoma; Menorrhagia; Neoplasms, Multiple Primary; Suture Techniques; Uterine Myomectomy; Uterine Neoplasms; Vasopressins

Topics: Endoscopes; Female; Gynecologic Surgical Procedures; Humans; Injections, Intralesional; Laparoscopy; Leiomyoma; Risk Assessment; Uterine Neoplasms; Vasopressins

To compare blood loss and need for blood transfusions in women who underwent abdominal myomectomies after receiving vasopressin or combined vasopressin and tourniquet.. A retrospective chart review was performed reviewing abdominal myomectomies that took place at our institution. Subjects were divided into three groups: no intervention, vasopressin, or combined vasopressin and tourniquet. Blood loss, need for blood transfusion, and drop in hemoglobin and hematocrit were compared across all groups.. One-hundred and thirty-two subjects were included in the study. No statistically significant difference was found between groups in blood loss, drop in hemoglobin or hematocrit, or blood transfusions.. Combined vasopressin and tourniquets was not associated with a statistically significant decrease in blood loss or need for blood transfusion.

Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Blood Volume; Female; Hematocrit; Hemostasis, Surgical; Humans; Leiomyoma; Middle Aged; Retrospective Studies; Tourniquets; Uterine Neoplasms; Vasopressins; Young Adult

Intramyometrial vasopressin injection reduces bleeding during myomectomy. Subsequent loss of peripheral pulses and nonmeasurable arterial blood pressure have been attributed to cardiovascular collapse or hypotension. When interpreted as global hypotension, treatment with vasopressors or according to Advanced Cardiac Life Support resuscitation protocols has been associated with cardiac complications. We describe a patient who developed loss of peripheral pulses and nonmeasurable blood pressure by noninvasive means after myometrial administration of 60 U vasopressin, with documented severe peripheral arterial vasospasm and elevated proximal blood pressure. We discuss the pathophysiology and emphasize the danger of misinterpreting pulselessness as global hypotension instead of vasospasm in this setting.

Topics: Adult; Anesthesia, General; Blood Pressure; Brachial Artery; Female; Hemodynamics; Humans; Injections; Leiomyoma; Myometrium; Peripheral Arterial Disease; Radial Artery; Ultrasonography; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Female; Humans; Leiomyoma; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Antibiotic Prophylaxis; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Hemostatics; Humans; Leiomyoma; Randomized Controlled Trials as Topic; Tourniquets; Uterine Neoplasms; Vasopressins

A thirty-year-old woman was scheduled for laparoscopic myomectomy. After insertion of an epidural catheter at the L4-5 interspace, general anesthesia was induced with thiopental 250 mg followed by vecuronium 8mg intravenously to facilitate tracheal intubation. General anesthesia was maintained with sevoflurane and nitrous oxide. Just after intramyometrial injection of vasopressin, blood pressure decreased from 122/66 to 45/25 mmHg, and heart rate decreased from 52 to 45 beats x min(-1). The patient was ventilated with 100% oxygen, and we administered atropine 0.25 mg and ephedrine 16 mg intravenously. Blood pressure increased to 150/100 mmHg and heart rate increased to 135 beats x min(-1). Since electrocardiogram showed ST-segment depression and premature ventricular contraction, we administered nicorandil 3 mg followed by continuous infusion at a rate of 3 mg x hr(-1), and lidocaine 60 mg, intravenously. The ST depression and premature ventricular contraction disappeared immediately. To decrease blood pressure and heart rate, we increased inspiratory concentrations of sevoflurane and nitrous oxide and administered local anesthetics via epidural catheter, and hemodynamic parameters became gradually stable. We estimate that severe hypotension observed in this case is associated with intramyometrial injection of vasopressin. Increased blood concentration of vasopressin might cause vasoconstriction of coronary artery, increases in afterload, and/or direct myocardial depression resulting in decreased cardiac output.

Topics: Adult; Anesthesia, General; Atropine; Ephedrine; Female; Humans; Hypotension; Injections; Intraoperative Care; Intraoperative Complications; Laparoscopy; Leiomyoma; Monitoring, Intraoperative; Myometrium; Severity of Illness Index; Uterine Neoplasms; Vasopressins

To test whether the relative insensitivity of craniofacial vessels to catecholamines differs in response to arginine vasopressin.. Prospective, observational human study.. University hospital.. 8 ASA physical status I and II women scheduled for elective myomectomy.. Patients underwent elective myomectomy surgery with intrauterine injection of arginine vasopressin.. Finger, ear, and forehead photoplethysmographs were monitored. Changes in the plethysmographic amplitudes were recorded before and after arginine vasopressin injection.. In all subjects, ear photoplethysmographic amplitude (but not oxygen saturation) decreased precipitously (62% +/- 10%; P < 0.001) after arginine vasopressin injection. In contrast, there was no significant decline in the finger signal (4.5% +/- 27%; P = 0.19). The forehead plethysmograph decreased in amplitude, but this finding did not achieve significance (33% +/- 18%; P = 0.18).. In contrast to prior observations during adrenergic activation, arginine vasopressin induced relatively greater vasoconstriction at the ear and forehead than at the finger. This finding has potential implications with respect to arginine vasopressin's effect on blood flow and indicates that monitoring the ear plethysmographic signal may provide useful information during arginine vasopressin administration.

Topics: Catecholamines; Ear; Female; Fingers; Forehead; Humans; Leiomyoma; Photoplethysmography; Prospective Studies; Vasoconstriction; Vasoconstrictor Agents; Vasopressins

Topics: Adult; Blood Pressure; Female; Humans; Injections; Leiomyoma; Pulse; Uterine Neoplasms; Vasopressins

To elucidate the mechanism by which myometrial vasopressin injection promotes hemostasis during myomectomy, we examined the expression of vasopressin V1a receptor transcripts in the myometrium. Vasopressin V1a receptor expression was ubiquitous, and the transcripts were detected in the myometrium not only of cycling and pregnant patients, but also of postmenopausal or GnRH agonist-treated patients. Based on these observations, we applied intraoperative myometrial vasopressin injection during myomectomy in a non-randomized study in a total of 84 patients. Vasopressin injection significantly reduced the intraoperative blood loss and postoperative hemoglobin fall in patients without and with GnRH agonist pretreatment. No serious complications occurred on account of the vasopressin injection. We conclude that intraoperative vasopressin injection is effective as a hormonal tourniquet even in GnRH agonist-pretreated myomectomy.

Topics: Adult; Blood Loss, Surgical; DNA Primers; Female; Gonadotropin-Releasing Hormone; Hemostasis, Surgical; Humans; Injections, Intralesional; Leiomyoma; Middle Aged; Receptors, Vasopressin; Reverse Transcriptase Polymerase Chain Reaction; Tourniquets; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Women with uterine fibromyomas may suffer from dysmenorrhea, menorrhagia or infertility, which all may be due to an effect of the fibroids on uterine activity. The effect of myomectomy on uterine contractility is unknown.. In women undergoing myomectomy because of dysmenorrhea, menorrhagia or infertility, intrauterine pressure was recorded before and three months after the operation on corresponding days of the menstrual cycle. Records were obtained during spontaneous uterine activity as well as after oxytocin and vasopressin challenge by intravenous bolus injections of 10 pmol/kg body weight. The area under the recording curve (AUC), maximal amplitude of uterine contractions and deformation index of uterine pressure recordings were measured.. In six women, in whom recordings could be obtained before and after operation on corresponding days of late follicular phase of the menstrual cycle, the AUC and maximal amplitude of contractions increased after myomectomy. The effect of oxytocin injection also varied, whereas no difference was seen in effect of vasopressin.. It is suggested that women with uterine fibromyomas may have disturbed uterine spontaneous contractions and responsiveness, which may be regulated by myomectomy.

Topics: Adult; Female; Humans; Hysterectomy; Infertility, Female; Leiomyoma; Oxytocin; Uterine Contraction; Uterine Neoplasms; Uterus; Vasopressins

To report a case of pulmonary edema after local injection of vasopressin at laparoscopy.. University teaching hospital.. A 24-year-old woman who underwent a laparoscopic myomectomy.. Injection of vasopressin (10 mL of 0.5 U/mL) into the uterine wall overlying the myoma.. Bradycardia, atrioventricular block, and pulmonary edema.. The use of vasopressin can be associated with severe cardiopulmonary complications.

Topics: Adult; Blood Pressure; Bradycardia; Female; Heart Rate; Humans; Injections; Laparoscopy; Leiomyoma; Myometrium; Pulmonary Edema; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Female; Hemostatics; Humans; Hysteroscopy; Laparoscopy; Leiomyoma; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Vasopressin may be associated with systemic hemodynamic changes, including severe myocardial ischemia, even in healthy patients. A 36-year-old woman underwent laparoscopy for the treatment of a uterine leiomyoma. After intravascular injection of vasopressin, she experienced life-threatening hypotension, and the procedure was subsequently aborted. After she recovered, she underwent successful laparoscopy without the use of vasopressin, and no complications occurred. As endogenous vasopressin levels sometimes rise during laparoscopy, patients may become susceptible to the drug's effects, and appropriate precautions must be taken.

Topics: Adult; Blood Pressure; Bradycardia; Female; Follow-Up Studies; Hemostatics; Humans; Hypotension; Injections; Intraoperative Complications; Laparoscopy; Leiomyoma; Reoperation; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

For better hemostasis in cases of operative pelviscopy in 60 patients Ornithine-8 Pitressin (POR 8) was applied locally as a vasoconstrictive agent in quantities of up to 50 ml at a concentration of 0.05 IU/ml. From the broad spectrum of indications for operative pelviscopy, the following procedures employing local application of a 5% POR 8 solution to produce intraoperative ischemia are described: Myoma enucleation, longitudinal salpingotomy with conception product extraction in the conservative treatment of a tubal pregnancy, ovarian cystectomy and salpingostomy. The tolerance was optimal no side effects were observed.

Topics: Endoscopy; Female; Hemostasis, Surgical; Humans; Leiomyoma; Ornipressin; Pregnancy; Pregnancy, Tubal; Salpingostomy; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Topics: Biomedical Research; Episiotomy; Felypressin; Female; Gynecology; Hemostatics; Humans; Leiomyoma; Obstetric Labor Complications; Obstetrics; Perineum; Phenylalanine; Pregnancy; Surgical Procedures, Operative; Toxicology; Uterine Neoplasms; Vasopressins

Topics: Female; Gynecologic Surgical Procedures; Hemostasis; Humans; Leiomyoma; Lysine; Phenylalanine; Surgical Procedures, Operative; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins