Giovanni Pecorella

Biologically-Based Notions About Uterine Bleeding During Myomectomy: Reasoning on Tradition and New Concepts

Uterine fibroids represent a prevalent category of tumors encountered in females of reproductive age, may present as singular or multiple entities and can manifest a variety of symptoms, which can negatively affect women’s daily lives. Pharmacological interventions may prove to be ineffective, occasionally costly, and associated with adverse effects. In instances where symptoms escalate in severity, myomectomy becomes a requisite as uterine-preserving operative therapy. Myomectomy can be performed utilizing laparoscopic, robotic, laparotomic, vaginal or hysteroscopic techniques. Given the abundant vascular supply to the myometrium, with blood being delivered to the uterus via the uterine arteries, myomectomy carries a considerable risk of significant hemorrhage during and subsequent to the surgical procedure, with the related complications. This paper aims to elucidate the conventional methodologies employed to mitigate hemorrhage during myomectomy and in the immediate postoperative phase, evaluating the effect of chemical interventions (such as vasopressin, octreotide, tranexamic acid, and uterotonics) alongside mechanical strategies (including uterine artery clamps, embolization, and tourniquets) to curtail bleeding during the myomectomy process. Furthermore, the potential of employing the intracapsular myomectomy technique without reliance on other traditional approaches was explored. This surgical method is grounded in the principles of the biological and anatomical characteristics of the fibroid, facilitating the enucleation of the myoma from its pseudocapsule. This anatomical entity, which is formed by the myoma throughout its development within the myometrium, enables the fibroid to be detached from the uterine musculature and supplies the requisite neurovascular support for its sustenance. Finally, the narrative review also shows how the intracapsular approach, which uses the fibroid’s biology, reduces bleeding during myomectomy.

Endometrial sampling in the absence of hysteroscopy: Insights from more than 1000 dilatation and curettage cases

Abstract Objectives The aim of this epidemiological study is to present the distribution of histopathological results of endometrial biopsies performed for indications in women and their relationship with symptoms. Methods A retrospective analysis was conducted on patients with abnormal uterine bleeding (AUB) assessed by endometrial biopsy between January 2020 and July 2022. Analyzing the distribution and association of patients' demographic traits, biopsy motivations, and histopathologic findings was the main goal of the study. Results A total of 1216 patients were included in the study, and their average age was 48.48 ± 8.79 years. AUB was found to be the most common reason for biopsy ( n  = 616; 50.7%). The most common diagnosis among the histologic findings (320; 26.3%) was endometrial polyp. The most common symptoms among individuals with premalignant and malignant diseases were AUB, endometrial thickening, and postmenopausal hemorrhage. Additionally, it was determined that 21 (6.3%) postmenopausal patients had inadequate material. Conclusions The most common histologic diagnosis from the procedure was endometrial polyp. It is important to make sure that the sample taken includes the entire uterine cavity because postmenopausal women may have insufficient biopsy samples. This is especially true if a hysteroscopy with biopsy cannot be performed (for a variety of reasons). In fact, suspect endometrial cancers should be thoroughly evaluated by hysteroscopy in patients with postmenopausal bleeding, endometrial thickness, and atypical uterine bleeding.

The impact of epigallocatechin gallate, vitamin D, and D-chiro-inositol on early surgical outcomes of laparoscopic myomectomy: a pilot study

A prospective investigation to assess the impact of 3 months of treatment with epigallocatechin gallate (EGCG), vitamin D and D-chiro-inositol (DCI) in the treatment of uterine fibroids (UF) with laparoscopic myomectomy as evidenced by surgical outcomes and effect on liver function. Non-pregnant or lactating women aged between 30 and 40 years were scheduled for laparoscopic myomectomy to treat symptoms or looking to conceive. After enrollment, patients were assigned to either (1) intervention group, assuming a total of 300 mg EGCG, 50 μg vitamin D, and 50 mg DCI divided in 2 pills per day for 3 months, or (2) control group, including untreated women scheduled to undergo laparoscopic myomectomy after 3 months. 91 patients completed the study. The comparison of the surgical outcomes between the intervention (n = 44) and the control (n = 47) groups revealed that the treatment significantly reduces the duration of surgery (41.93 ± 7.56 min vs 56.32 ± 10.63 min, p < 0.001). Moreover, the treatment also reduced blood loss during surgery (149.09 ± 25.40 mL vs 168.41 ± 21.34 mL, p < 0.001), resulting in treated patients having higher Hb levels at discharge 11.27 ± 0.82 mL vs 10.56 ± 0.82 mL, p < 0.01). The surgery induced an increase in AST and in total bilirubin regardless of the assigned group, and the treatment induced no change in liver function. Our data suggest that EGCG plus vitamin D, and DCI could represent a safe option for women with UF scheduled for laparoscopic myomectomy, improving surgical outcomes without affecting liver functionality.