Abstract：
OBJECTIVE: To determine the median perioperative blood loss (PBL) during minimally invasive surgical (MIS) myomectomy.
METHODS: Prospective pilot study.
METHODS: Large academic teaching hospital.
METHODS: Thirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging.
METHODS: A CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit - postoperative hematocrit)/preoperative hematocrit.
RESULTS: Median PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion.
CONCLUSIONS: Calculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.
METHODS: Prospective pilot study.
METHODS: Large academic teaching hospital.
METHODS: Thirty-one patients underwent laparoscopic or robotic myomectomy and completed a postoperative complete blood count (CBC) from November 2020 to August 2022. Patients had to have at least one fibroid greater than or equal to 3 cm on preoperative imaging.
METHODS: A CBC was collected preoperatively within 7 days of surgery. Estimated blood loss (EBL) was determined by the surgeon intraoperatively. A repeat CBC was drawn between postoperative days 2 through 4. PBL was calculated using the equation PBL = (patient weight in kg × 65 cc/kg) × (preoperative hematocrit - postoperative hematocrit)/preoperative hematocrit.
RESULTS: Median PBL (536.3 cc [270.0, 909.3]) was greater than median EBL (200.0 cc [75.0, 500.0]). PBL ranged from a net gain of 191.5 cc to net loss of 2362.5 cc. Median size of the largest fibroid on preoperative imaging was 8.8 cm (6.6, 11.5), and median weight of fibroids removed was 321 g (115, 519). About half of patients (51.6%) had one fibroid removed, and 48.4% had 2 or more fibroids removed. Five patients were converted to laparotomy, 4 from robotic approaches. Two patients required a blood transfusion.
CONCLUSIONS: Calculated PBL was greater than intraoperative EBL. This suggests there is continued blood loss post myometrial bed closure. Blood loss should be evaluated both during and after myomectomy, as intraoperative EBL underestimates total PBL.
摘要：
目的：确定微创手术（MIS）子宫肌瘤切除术围手术期的中位失血量（PBL）。
方法：前瞻性试点研究。
方法：大型学术教学医院。
方法：从2020年11月至2022年8月，31例患者接受了腹腔镜或机器人子宫肌瘤切除术，并完成了术后全血细胞计数（CBC）。在术前成像时，患者必须至少有一个大于或等于3cm的纤维瘤。
方法：术前收集术后7天内的CBC。估计的失血量(EBL)由外科医生术中确定。在术后第2天至第4天之间重复绘制CBC。使用等式PBL=(患者体重,kg×65cc/kg)×(术前血细胞比容-术后血细胞比容)/术前血细胞比容计算PBL。
结果：PBL中位数（536.3cc（270.0，909.3））大于EBL中位数（200.0cc（75.0，500.0））。PBL从191.5cc的净收益到2362.5cc的净损失不等。术前最大肌瘤的中位大小为8.8cm（6.6，11.5），切除肌瘤的中位重量为321gm（115，519）。51.6%的患者切除了一个肌瘤，48.4%的患者切除了两个或两个以上的肌瘤。五名患者被转换为剖腹手术，四个来自机器人方法。两名患者需要输血。
结论：计算的PBL大于术中EBL。这表明子宫肌层床闭合后有持续的失血。应在子宫肌瘤切除术期间和之后评估失血量，术中EBL低估了总PBL。
方法：前瞻性试点研究。
方法：大型学术教学医院。
方法：从2020年11月至2022年8月，31例患者接受了腹腔镜或机器人子宫肌瘤切除术，并完成了术后全血细胞计数（CBC）。在术前成像时，患者必须至少有一个大于或等于3cm的纤维瘤。
方法：术前收集术后7天内的CBC。估计的失血量(EBL)由外科医生术中确定。在术后第2天至第4天之间重复绘制CBC。使用等式PBL=(患者体重,kg×65cc/kg)×(术前血细胞比容-术后血细胞比容)/术前血细胞比容计算PBL。
结果：PBL中位数（536.3cc（270.0，909.3））大于EBL中位数（200.0cc（75.0，500.0））。PBL从191.5cc的净收益到2362.5cc的净损失不等。术前最大肌瘤的中位大小为8.8cm（6.6，11.5），切除肌瘤的中位重量为321gm（115，519）。51.6%的患者切除了一个肌瘤，48.4%的患者切除了两个或两个以上的肌瘤。五名患者被转换为剖腹手术，四个来自机器人方法。两名患者需要输血。
结论：计算的PBL大于术中EBL。这表明子宫肌层床闭合后有持续的失血。应在子宫肌瘤切除术期间和之后评估失血量，术中EBL低估了总PBL。
