Laparoscopic Enucleation of a Cervical Myoma and Reconstruction of Cervical Canal
Bibliographic record
Abstract
OBJECTIVE Uterine myoma is a prevalent benign tumor in the reproductive tract of females, which is estimated to occupy 25%–30% of the incidence in reproductive-age females.[1] While many patients remain asymptomatic, those with heavy uterine bleeding, severe pelvic pain, or infertility may require surgery. The usual treatment involves surgery.[2] Nevertheless, medical approaches such as hormonal therapy using gonadotropin-releasing hormone agonists or uterine artery embolization are desired. Surgical management includes laparotomy or laparoscopy. However, laparoscopic myomectomy removing cervical myomas is challenging due to difficulties in resection, enucleation, and suture defects of the myometrium, which lead to increased blood loss and surgical time.[3-5] This study aims to illustrate the viability of excision of cervical myoma and reconstruction of the cervical canal laparoscopically. DESIGN We make a video presentation of the surgical procedure (Canadian Task Force Classification III-C). Video (laparoscopic cervical myomectomy and reconstruction of the cervical canal). PATIENT A 42-year-old nulliparous woman presented with menorrhagia for 5 months. Ultrasonography revealed a 4.5 cm × 3.2 cm myoma in the cervical region and another myoma 3.7 cm × 3.7 cm intramural myoma in the posterior wall. Laparoscopic myomectomy was recommended for her menorrhagia-caused anemia. Her hemoglobin was 6.8 g/dL and rose to 8.0 g/dL after blood transfusion. INTERVENTION The laparoscopic port setting included one glove port (NELIS, Gyeonggi-do, South Korea) and two axillary ports. Before the incision, a 1:50 dilution of vasopressin was injected into the myoma region. No uterine artery occlusion was performed before the myomectomy.[6] The procedure involved a longitudinal incision using a unipolar scissor, fixation with a myoma screw, and enucleation by Ligasure instrument (Medtronic, Minneapolis, MN, USA) [Figure 1]. After the enucleation of myoma, the cervical canal was exposed. After inserting a #8 Foley catheter through the cervical external os under laparoscopic direct vision, the cervical canal was closed with 1-0 V-loc (Medtronic) in multiple layers. During the surgery, the total amount of blood lost was 125 mL, the myoma weighed 85 g, and the procedure lasted around 143 min. The surgery went smoothly without complications, and the patient was discharged 2 days later. The intrauterine catheter was removed on the discharge day. No issues were noted at the follow-up. Histopathological inspection revealed leiomyoma of the uterus.Figure 1: Laparoscopic cervical myomectomy. http://www.apagemit.com/page/video/show.aspx?num=332&kind=2&page=1CONCLUSION The laparoscopic treatment of cervical myomas and the reconstruction of the cervical canal pose a challenge, yet it seems to be a viable and secure surgical alternative. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Author contributions Conceptualization: D-C.D.; methodology: N-S.T.; software: N-S.T.; validation: D-C.D.; video eiting: N-S.T. and D-C.D.; formal analysis: D-C.D.; interpretation of N-S.T. and D-C.D.; resources: D-C.D.; data curation: N-S.T. and D-C.D.; writing: N-S.T. and D-C.D.; original draft preparation: N-S.T. and D-C.D.; review and editing: N-S.T. and D-C.D.; supervision: D-C.D. All authors have read and agreed to the published version of the manuscript. Data availability statement All data generated or analyzed during this study are included in this published article. Financial support and sponsorship Nil. Conflicts of interest Prof. Dah-Ching Ding, an editorial board member at Gynecology and Minimally Invasive Therapy, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".