UNASSIGNED: Pain is a major challenge in performing ultrasound-guided percutaneous microwave ablation (PMWA) of uterine myomas. Inadequate analgesia by local anesthetics hinders the possibility of conducting PMWA of uterine myomas in the Ambulatory Surgery Center (ASC) of the Department of Ultrasound.
UNASSIGNED: The superior hypogastric plexus (SHP) forms a suitable target for pain relief through the blockade, as it contains nociceptive afferent fibers from pelvic organs such as the uterus, rectum, and bladder. Superior hypogastric plexus block (SHPB) has demonstrated promise as an alternative treatment option for alleviating pelvic pain, reducing opioid consumption, and improving quality of life. This study aims to evaluate the efficacy of ultrasound-guided SHPB combined with conscious sedation as an alternative anesthesia option for ambulatory patients receiving ultrasound-guided PMWA of uterine myomas.
UNASSIGNED: This randomized controlled trial (RCT) will be carried out at the Department of Ultrasound, The First Affiliated Hospital of Xiamen University. Women scheduled for ultrasound-guided PMWA of uterine myomas will be eligible. 86 patients will be recruited and randomly assigned to either the intervention or control groups in a 1:1 ratio. The intervention group will undergo ultrasound-guided superior hypogastric plexus block (SHPB) combined with conscious sedation, while the control group will receive local anesthesia combined with conscious sedation. The primary outcome is the success rate of anesthesia, secondary outcomes include vasoactive drug consumption, acetaminophen consumption, sleep quality, sonographer satisfaction score, patient satisfaction score, the detained time in hospital, and adverse events.
UNASSIGNED: This RCT represents the inaugural effort to specifically evaluate the safety and efficacy of ultrasound-guided SHPB combined with conscious sedation in patients undergoing ultrasound-guided PMWA of uterine myomas and will provide valuable evidence and insight into the analgesic management of this ambulatory surgery.
UNASSIGNED: This study has been approved by the Ethics Committee of the First Affiliated Hospital of Xiamen University (Scientific Research Ethics Review 2023, No. 139). The results will be submitted for publication in peer-reviewed journals.

Uterine myomas affect 70% of women of reproductive age, potentially impacting their fertility and health. Manual film reading is commonly used to identify uterine myomas, but it is time-consuming, laborious, and subjective. Clinical treatment requires the consideration of the positional relationship among the uterine wall, uterine cavity, and uterine myomas. However, due to their complex and variable shapes, the low contrast of adjacent tissues or organs, and indistinguishable edges, accurately identifying them in MRI is difficult. Our work addresses these challenges by proposing an instance segmentation network capable of automatically outputting the location, category, and masks of each organ and lesion. Specifically, we designed a new backbone that facilitates learning the shape features of object diversity, and filters out background noise interference. We optimized the anchor box generation strategy to provide better priors in order to enhance the process of bounding box prediction and regression. An adaptive iterative subdivision strategy ensures that the mask boundary details of objects are more realistic and accurate. We conducted extensive experiments to validate our network, which achieved better average precision (AP) results than those of state-of-the-art instance segmentation models. Compared to the baseline network, our model improved AP on the uterine wall, uterine cavity, and myomas by 8.8%, 8.4%, and 3.2%, respectively. Our work is the first to realize multiclass instance segmentation in uterine MRI, providing a convenient and objective reference for the clinical development of appropriate surgical plans, and has significant value in improving diagnostic efficiency and realizing the automatic auxiliary diagnosis of uterine myomas.

UNASSIGNED: Uterine artery occlusion (UAO) is a minimally invasive approach often used to treat symptomatic uterine myomas. This study aimed to compare the clinical effects of laparoscopic UAO (LUAO) in combination with laparoscopic myomectomy (LM) with LM alone to treat symptomatic multiple uterine myomas.
UNASSIGNED: This was a prospective observational study. In total, 122 patients with symptomatic multiple uterine myomas underwent LUAO + LM or LM alone between April 2015 and October 2017. The surgical procedure time, blood loss, highest postoperative temperature, hospital length of stay, number of removed myomas, surgical complications, and recurrence rate of the two groups were compared.
UNASSIGNED: Mean blood loss was significantly lower in the LUAO + LM group compared with the LM group (177.97 ± 104.09 mL vs 258.10 ± 119.55 mL, p < 0.05). No significant difference in surgical procedure time, hospital length of stay, highest postoperative temperature, and surgical complications was found between the LUAO + LM group and LM group. The number of removed myomas was considerably higher in the LUAO + LM group than in the LM group (4[4-7] vs 3[3-5], p < 0.05). The recurrence rate in the LUAO + LM group was considerably lower than that in the LM group (6.2% vs 25.9%).
UNASSIGNED: LUAO in combination with LM was associated with higher surgical quality and lower recurrence of myomas compared with LM alone. LUAO in combination with LM is recommended for women with symptomatic multiple uterine myomas who wish to retain their uteruses.

The aim of this study was to evaluate the safety, feasibility, and effectiveness of transvaginal myomectomy surgery.
We conducted a retrospective study in Shengjing Hospital of China Medical University. In all, 138 patients underwent transvaginal myomectomy from March 2009 to March 2019. The perioperative clinical data, suchas position and size of myomas, operative duration, blood loss, intraoperative and postoperative complications, and hospitalizationtime were retrospectively analyzed.
All transvaginal myomectomies were performed without conversion to laparotomy. The mean vaginal operatingtime was 56.0 (± 17.2) minutes. The mean operative estimated blood loss was 89.2 (± 36.8) mL. No significant intraoperativecomplications occurred. The median time of intestinal function recovery after operation was 1 day (range 1-4 days).The median time of hospital stay was 4 days (range 3-10 days); 12 (8.7%) patients experienced postoperative morbidity.
Transvaginal myomectomy is a minimally invasive surgery that can be performed without leaving a scar onthe body surface. It can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indicationfor this approach.

This study is to compare the outcomes of tri-acryl gelatin microspheres (TAGM) and polyvinyl alcohol (PVA) in the treatment of uterine myomas with uterine artery embolization (UAE). Meta-analysis was performed by electronic literature searches from databases including Cochrane Central Register of Controlled Trials, PubMed, EMBASE and meta Register of Controlled Trials for studies published prior to December 2014. Randomized controlled trials comparing TAGM and PVA treating uterine myomas were included in the analysis. Information retrieved from each study included study design, number of participants, study settings, patient characteristics, sample size, follow-up duration and outcomes. Imaging outcomes and clinical outcomes were the main criteria for the evaluation of the included studies. Twenty-eight articles published from 1966 to December 2014 were retrieved through database searching and other sources. After initial screening and assessment, five randomized controlled trials, including 309 women with uterine myomas, met the inclusion criteria. In both imaging and clinical outcomes, TAGM group showed superior or similar effects than PVA group. The results showed more number of patients with significant tumor enhancement, greater mean change in tumor volume, greater mean changes in symptom score and QOL score in TAGM group compared with PVA group, with significant differences. TAGM and PVA groups had similar uterine volume, mean changes in bleeding score and pain score. TAGM is better than PVA as an embolic agent in the treatment of uterine myomas with UAE.

OBJECTIVE: To assess the quality of life (QoL) of women at 1 and 12 months after ultrasound-guided high-intensity focused ultrasound (USgHIFU) treatment as compared with laparoscopic myomectomy for treatment of symptomatic uterine myomas.
METHODS: Nonrandomized prospective clinical trial (Canadian Task Force classification II-2).
METHODS: Urban university-based hospital in China.
METHODS: One hundred thirty premenopausal women underwent USgHIFU (n = 89) or laparoscopic myomectomy (n = 41) for treatment of symptomatic uterine myomas.
RESULTS: Eighty-three patients in the HIFU group and 39 in the surgical group were followed up at 1 and 12 months. QoL was assessed using the Medical Outcomes Study 36-Item Short-Form General Health Survey, which showed no significant differences between groups in any of the 8 subscales at the 12-month follow-up visit. Symptom score, willingness to recommend the treatment to a friend, hospital stay, and recovery period were compared between the 2 groups. In the HIFU group, hospital stay was shorter (mean [SD] 2.9 [1.5] days vs 6.2 [2.7] days; p <.001) and patients resumed normal activities sooner (4.5 [1.5] days vs 10.9 [3.8] days; p <.001). Significant clinical complications and adverse events after each treatment were documented and compared, and HIFU yielded significantly better results.
CONCLUSIONS: Compared with laparoscopic myomectomy, HIFU treatment of symptomatic uterine myomas leads to comparable QoL and symptom improvement, fewer significant clinical complications and adverse events, shorter hospital stay, and faster recovery. Randomized studies with long-term follow-up are needed to reach definitive conclusions insofar as HIFU treatment of uterine myomas.