Hemorrhage: A strong indicator for myomectomy-related complication

Uterine fibroid (leiomyoma or myoma) is the most common benign uterine tumor, accounting for 20e60% of cases in women of reproductive age. Three variant-subcategories include: (1) ordinary leiomyomadbenign, including nondegenerated and degenerated [cystic, hemorrhagic (carneous), fatty (lipoleiomyoma), hyaline, and myxoids]; (2) leiomyoma variantsdunclassified (mitotically active, cellular, atypical, and smooth muscle tumors of uncertain malignant potential); and (3) leiomyosarcomadmalignant. The use of a uterinepreservation strategy, including medical or surgical treatment rather than hysterectomy, to treat uterine myoma has become popular, because it not only provides adequate symptom control, but also preserves fertility. Advanced surgical instruments, including new and innovative laparoscopic techniques with and without robotics-assisted systems, have allowed a greater number of gynecologic surgeons to use laparoscopic surgery in place of conventional exploratory laparotomy in the management of various kinds of diseases, including some gynecological malignancies. Furthermore, these so-called minimally invasive surgeries claim to have many patient-focused benefits, such as a decreasing risk of postoperative adhesion, promoting rapid recovery, and cosmetic advantages. However, the malignant form (leiomyosarcoma) is difficult to differentially diagnose clearly between benign and malignant tumors, resulting in an almost impossible presurgical diagnosis and contributing to the elevated possibility of widespread malignant tumors during and after operation, especially for those surgeries using morcellation. An increasing number of surgeons are hesitant, and some are outright opposed, to this approach in the management of uterine fibroids. Therefore, conventional laparotomy has regained a measure of popularity. Moreover, as surgical techniques have continued to advance, it is now possible to shorten the incision wound (ultramini-laparotomy), enabling patients to receive benefits similar to those of traditional laparoscopic surgery. Therefore, abdominal myomectomy is still considered the best choice for women with fibroids and who need to maintain their reproductive function. The study by Çinar et al in this issue of the Journal of the Chinese Medical Association entitled, “Association of clinical outcomes and complications with obesity in patients who