participants receive a single dose of 400mcg vaginal misoprostol preoperatively (60minutes before) during open myomectomy

Uterine Fibroid

insertion of a preoperative single dose 400 micrograms of Misoprostol Pfizer Brand placed vaginally

Misoprostol Pfizer Brand

participants in this arm will receive the standard of care which in our setting involves the use of either a tourniquet to control intraoperative blood loss especially if the fibroids are large or rarely, other interventions like oxytocin, tranexamic acid, vasopressin and occasionally not using either of the interventions.

Non-insertion of Misoprostol Pfizer Brand

Makerere University

The Efficacy and Safety of Preoperative Misoprostol in Blood-loss Reduction During Myomectomy.

Efficacy and Safety of Pre-operative Vaginal Misoprostol in Reduction of Intraoperative Blood Loss During Myomectomy. Amulticentre Single Blind Randomized Trial.

Soaked mops will be weighed and blood loss estimated by subtracting the soaked weight from the dry weight and by multiplying this by 1.060 (average density of human blood is 1.06g/ml); a volume in ml would be acquired. Only mops are intended to be routinely used during the operation for cleaning and clearing the operation field although measurement of blood collected in the suction cylinder in milliliters if used will also be added. Adequate mops will be provided to avoid any spillage onto the operating table polythene sheet. A standardized digital weighing scale will be availed in each operating room. Any spillage onto the bed, however, will be collected in a polythene sheet and poured into a measuring cylinder for quantification.

from incision time to time for insertion of last stitch

number of days spent within the hospital post-operatively

hemodynamic instability during and after open myomectomy following profuse hemorrhage as assessed by the clinicians.

death, massive transfusion >5 units of blood, development of deep venous thrombosis pulmonary edema and pulmonary embolism

Hemoglobin estimation done both pre- and post-operatively; difference between the two values to be a measure of amount of blood lost. patients that receive blood transfusion to be excluded.

College of Health Sciences

Principal Investigator

multicenter-randomized single blind controlled trial with a (1:1) allocation ratio.

Careful examination under anesthesia. Catheterization by N. 18 Foley's catheter . A transverse lower abdominal incision (Pfannenstiel incision) . the corpus is amputated just below the level of the isthmus and then the endocervical canal is electrocoagulated using monopolar electrocautery. The cervical stump is closed using vicryl 0 sutures.
Intraoperative antibiotics The abdomen is closed in layers; the wound is covered with a sterile dressing. All specimens were sent for pathological examination .

examination under anesthesia. Catheterization by N. 18 Foley's catheter A transverse lower abdominal incision (Pfannenstiel incision) The urinary bladder is dissected off the lower uterine segment of the uterus and cervix by blunt or sharp dissection. Blunt dissection is done . Sharp dissection using Metzenbaum scissors is performed in patients with previous cesarean sections Revision of all pedicles to ensure hemostasis. Intraoperative antibiotics The abdomen is closed in layers; the wound is covered with a sterile dressing. All specimens were sent for pathological examination .

Sexual Function Disturbances

Urinary Function Disorders

A transverse lower abdominal incision (Pfannenstiel incision) The corpus is amputated just below the level of the isthmus and then the endocervical canal is electrocoagulated using monopolar electrocautery. The cervical stump is closed using vicryl 0 sutures.
Revision of all pedicles to ensure hemostasis. Intraoperative antibiotics . The abdomen is closed in layers; the wound is covered with a sterile dressing.

subtotal hystrectomy

A transverse lower abdominal incision (Pfannenstiel incision) The urinary bladder is dissected off the lower uterine segment of the uterus and cervix by blunt or sharp dissection. Revision of all pedicles to ensure hemostasis.
The abdomen is closed in layers; the wound is covered with a sterile dressing.

Total hystrectomy

Kasr Alainy medical school

Urinary and Sexual Functions After Subtotal Versus Total Abdominal Hysterectomy

The patient presented with a symptomatically full bladder. She voided spontaneously in a uroflow chair. Maximum flow rate and postvoid residual urine volume were obtained via a transurethral catheter. The microtransducer catheters were connected to the appropriate cables and to the tubing from the water pump. With the patient in the supine position on a urodynamic chair, the abdominal catheter was placed into the vagina. A dual microtransducer 6-French catheter with a filling port was then placed into the bladder. The patient was moved to a sitting position. After the catheters were appropriately placed, the subtraction was checked by asking the patient to cough. Cough-induced pressure spikes should be seen on the Pves and Pabd channels, but not on the true detrusor pressure channel.

The urinary bladder was filled with normal saline at room temperature with a filling rate 50-100 ml/min. First desire to void and strong desire to void were recorded. Throughout the filling portion of the examination, the patient was asked to perform provocative activities, such as coughing and straining. The external urethral meatus was constantly observed for any involuntary urine loss.

Satisfaction with sexual life (satisfied-not satisfied).

Ahmed Maged

Professor

Cairo University

Vaginal Natural Orifice Transluminal Endoscopic Surgery

Natural Orifice Endoscopic Surgery

Disease, Adnexal

Laparoscopic Surgery

Surgical removal of one or both adnexa by a natural orifice transluminal endoscopic surgical technique using a colpotomy (transvaginal incision)

vNOTES adnexectomy

Surgical removal of one or both adnexa by transabdominal laparoscopy

Laparoscopic adnexectomy

Imelda Hospital

Notes Adnexectomy for Benign Pathology Compared to Laparoscopic Excision

Adnexectomy for Benign Gynaecological Pathology by Natural Orifice Transluminal Endoscopy or Laparoscopy

The proportion of women successfully treated by removing the adnexal mass without spill, using a dichotomous outcome measure, will be used as a measure of efficacy.

The proportion of women discharged the same day based on their own preference, as a dichotomous outcome. The decision to discharge or to admit to hospital for the night will be based solely on the choice of the woman to return home the same day or stay overnight.

Postoperative pain scores, as an ordinal outcome, measured using a VAS scale twice daily from day 1 till 7 self-reported by the participating women

Postoperative pain defined by the total amount of analgesics used as described in the standardized pain treatment protocol, as a continuous outcome.

Postoperative infection defined by lower abdominal pain with fever > 38°C and positive clinical signs or laboratory findings, detected during the first six weeks of surgery, as a dichotomous outcome.

Per- or postoperative complications according to the Clavien- Dindo classification detected during the first six weeks of surgery, as a dichotomous outcome

The proportion of women readmitted to hospital within six weeks of surgery, as a dichotomous outcome

Incidence and intensity of dyspareunia recorded by the participants at 3 and 6 months by self-reporting using a simple questionnaire and VAS scale, as a dichotomous and ordinal outcome

Sexual wellbeing at baseline, at 3 and 6 months by self-reporting using the SSFS (Short Sexual Function Scale).

Duration of surgery measured as the time in minutes from the insertion of the bladder catheter to the end of vaginal/abdominal wound closure, as a continuous outcome

Calculating the comparative direct costs of both techniques up to 6 weeks after the surgical intervention

Health-related quality of life, at baseline, at 3 and 6 months by self-reporting the EQ-5D-3L questionnaire

Interim analyses of major endpoints will be supplied, in strict confidence, to an independent Data Monitoring and Ethics Committee (DMEC) along with updates on results of other related studies, and any other analyses that the DMEC may request.

dyspareunia/hitasótt

The Efficacy and Safety of Preoperative Misoprostol in Blood-loss Reduction During Myomectomy.

Urinary and Sexual Functions After Subtotal Versus Total Abdominal Hysterectomy

Notes Adnexectomy for Benign Pathology Compared to Laparoscopic Excision

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