Trends in the Surgical Treatment of Benign Uterine Tumors: Conservative vs. Radical Approaches
Chyi-Long Lee
Abstract
Celebrating over a decade since its inception, our journal “Gynecology and Minimally Invasive Therapy” proudly reached a significant milestone with our first impact factor of 1.2 and a Scopus database index of 1.9 in 2022. Looking ahead, we aspire to attract a greater influx of high-quality contributions and extend our heartfelt gratitude to all editors, reviewers, and authors for their unwavering support of GMIT journal. In this volume 13 issue 3, we have many outstanding papers published that are worth reading. The article “Myomectomy: Choosing the Surgical Approach-A Systematic Review” discusses various surgical methods for treating uterine fibroids in women, focusing on the shift from traditional abdominal surgeries to minimally invasive techniques such as laparoscopic, hysteroscopic, robotic, and natural orifice/vaginal approaches. It outlines the advantages and drawbacks of each method, highlighting the importance of standardized training and increased awareness among gynecologists for safe and effective myomectomy practices. The article titled “Correlation between pelvic diameter and different surgical procedures for exogenous cervical leiomyoma” examines the role of pelvic diameter in guiding surgical decisions for cervical leiomyomas. It compares laparoscopic and laparotomy approaches and finds that the ratio of tumor diameter to pelvic diameter correlates with surgical plan selection. While laparoscopic procedures showed advantages in certain aspects, the study suggests pelvic diameter can aid in evaluating surgical difficulty. The article titled “Four-Handed Technique for Total Laparoscopic Hysterectomy (FTH-TLH): An Italian Experience” compares FHT-TLH to traditional TLH methods, focusing on surgical outcomes and educational benefits. Results show that FHT-TLH resulted in shorter operative times, reduced blood loss, and shorter hospital stays. The discussion emphasizes the advantages of FHT-TLH for patients and surgical trainees, highlighting its potential to improve surgical skills and outcomes. Further research is needed to explore long-term outcomes and wider adoption of FHT-TLH techniques. We believe FHT combined with using the Lee-Huang point will make the procedures easier and more effective.[1,2] The case report titled “Trocar site herniation after laparoscopic myomectomy via culdotomy extraction” discusses a rare but potentially life-threatening complication of laparoscopic surgery, trocar-site hernia (TSH), specifically focusing on a case of 5-mm trocar site bowel herniation following laparoscopic myomectomy. By presenting a rare case and discussing relevant risk factors and management strategies, the paper contributes to the understanding of TSH and highlights the importance of vigilance in postoperative care. Potential research avenues stemming from this paper include prospective studies to assess the efficacy of fascial closure in preventing TSH, as well as investigations into the impact of patient characteristics and surgical techniques on TSH risk. All papers are worth reading since choosing the right way to go, knowing the difficulty of surgery and the risk of TSH are important in myoma treatment by minimally invasive therapy. The article titled “Improvement in Quality of Life after Laparoscopic or Robotic-assisted Sacrocolpopexy with a Single Anterior Mesh in Patients with Pelvic Organ Prolapse” examined the outcomes of laparoscopic- or robotic-assisted sacrocolpopexy using a single anterior mesh in patients with pelvic organ prolapse (POP) but without posterior vaginal wall prolapse. One notable advantage of the single anterior mesh procedure was the improvement in QOL without severe complications. The study adds to existing literature by demonstrating the effectiveness of this procedure in improving patient outcomes. The results of this study are compatible with previous study in GMIT.[3,4] In addition, the study addressed the limitations of the double mesh procedure, highlighting the potential benefits of minimizing the number of meshes used. The strengths of the article titled “Various laparoscopic techniques in pelvic organ prolapse surgery” include its comprehensive review of various laparoscopic techniques, supported by the authors’ clinical experience and relevant literature. The inclusion of surgical outcomes and comparisons between different approaches adds credibility to the discussion. In addition, the paper addresses the evolving landscape of POP surgery, particularly the transition away from transvaginal mesh implants due to safety concerns. We believe that these articles will be helpful to all readers in the field of pelvic reconstructive surgery. Author contributions Chyi-Long Lee has participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, writing, or revision of the manuscript. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Editor-in-Chief