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.