Introduction
Uterine leiomyomas(fibroids, myomas) are the most common benign
gynecologic tumors in women of reproductive age, the prevalence of which
depends on the patient’s age, race, and method of detection.(1) The
majority of patients with uterine fibroids have no symptoms, but a few
have related symptoms, including menstrual disorders such as
menorrhagia, dysmenorrhea, and acute abdominal pain caused by myoma
degeneration.(2, 3) Myomectomy is the treatment for women of
reproductive age who want to be pregnant and retain their fertility
potential, as well as patients who desire to preserve their uterus.(4,
5) It has been confirmed that laparoscopic myomectomy can lighten
postoperative pain, reduce postoperative fever rates and shorten
hospitalization time after the intervention.(6, 7) The development of
laparoendoscopic single site surgery (LESS) is more rapid, resenting the
future of some laparoscopic surgery.(8)
LESS was first applied in gynecology in 1971. (9) Compared with
conventional laparoscopic surgery, LESS can reduce the risk of trocar
complications, lighten postoperative pain and require fewer incisions,
thus improving the cosmetic effect.(10, 11) LESS-M is considered to be a
feasible and safe treatment technique.(12) The application of LESS-M in
the treatment of uterine fibroids is becoming more and more popular.
However, no study has yet evaluated hidden blood loss (HBL) either in
LESS-M or CLM.
To our best knowledge, the conception of hidden blood loss (HBL) was
proposed by Sehat et al. in the year 2000 for the first time.(13) In
recent years, it has been demonstrated that HBL accounts for a large
proportion of blood loss in laparoscopic surgery. Zhou et al. reported
that the mean HBL in minimally invasive transforaminal lumbar interbody
fusion was 488.4 ± 294.0ml, 52.5% of TBL.(14)
The complications of perioperative hemorrhage can also not be avoided in
laparoscopic myomectomy. (15) Surgeons often underestimate the
significant impact of HBL on blood loss. HBL may lead to anemia, prolong
bed time, and increase the chance of infection if it is not monitored
and treated. (14)
In our study, we performed a retrospective review to investigate HBL
during LESS-M and CLM. We quantify the HBL and explore the risk factors
for HBL in patients undergoing laparoscopic myomectomy. The results may
help us to clarify the actual blood loss during LESS-M and CLM, which
can improve the accuracy of perioperative blood loss assessment,
optimize the rehydration support treatment scheme, and accelerate the
recovery of patients.