Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases
Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morc...
Saved in:
Published in | Case reports in obstetrics and gynecology Vol. 2016; no. 2016; pp. 1 - 4 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Cairo, Egypt
Hindawi Publishing Corporation
01.01.2016
Hindawi Limited Wiley |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases). We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure’s selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one. |
---|---|
AbstractList | Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases). We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure's selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one. |
Author | Flores-Manzur, María de los Ángeles Ayala-Yáñez, Rodrigo Alfaro-Alfaro, Jaime Nevarez-Bernal, Roberto |
AuthorAffiliation | ABC Medical Center, Mexico City, Mexico |
AuthorAffiliation_xml | – name: ABC Medical Center, Mexico City, Mexico |
Author_xml | – sequence: 1 fullname: Ayala-Yáñez, Rodrigo – sequence: 2 fullname: Nevarez-Bernal, Roberto – sequence: 3 fullname: Flores-Manzur, María de los Ángeles – sequence: 4 fullname: Alfaro-Alfaro, Jaime |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27668110$$D View this record in MEDLINE/PubMed |
BookMark | eNqNkktvEzEUhUeoiJbSHWtkiQ0ShPoxD8-mUjXiESkRkQpry2PfaRzNjIM9Schf4ldypwmBssKba_l8PvK9Ps-Ts973kCQvGX3PWJZdc8ry67SgWVHSJ8kFpyWd5HnJz057mZ4nVzGuKK6ccsHLZ8k5L1BgjF4kPyvfrVv4QWZ6rYOPxq-dIfO978AMvtuTnRuW5A62EIDc2iVE5_tIFhAaHzqwB30R_BoCFuT6wW2BzEHHTYBIdG_Jwu9QnftgoG31gA7jja2zo07udAOkWnpngLieVBAGjXXaN7hzrRv2pNIR4ovkaaPbCFfHepl8-_jha_V5MvvyaVrdziZGCGy5gKZucs2zXNZNYbllhjfCyDQTsha0zITNgRaytrXOtMgLKzMpRJ7KvJSWGnGZTA--1uuVWgfX6bBXXjv1cODDvdL4MNOCqo2lmvE0BU5TNC2pzNMMagZ5rQ2v0evm4LXe1Dgtg9MJun1k-ljp3VLd-63KqKApL9DgzdEg-O8biIPqXHwYYw9-ExWTHJsuUjmir_9BV34TehzVSNEsLTEBSL07UAZ_OwZoTo9hVI2ZUmOm1DFTiL_6u4ET_DtBCLw9AEvXW71z_2kHyECj_9CMMvwg8Qvoh-H9 |
Cites_doi | 10.1007/s10397-013-0824-2 10.1016/j.jmig.2007.09.012 10.1016/j.jmig.2014.04.010 10.1002/14651858.cd004638.pub3 10.1016/j.jmig.2014.05.010 10.1016/j.fertnstert.2015.12.133 10.1016/j.ejogrb.2010.02.017 10.1016/j.ajog.2012.01.046 10.1016/s1701-2163(15)30338-8 10.1007/s10397-012-0764-2 10.1016/j.ejogrb.2009.03.009 |
ContentType | Journal Article |
Copyright | Copyright © 2016 Jaime Alfaro-Alfaro et al. Copyright © 2016 Jaime Alfaro-Alfaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2016 Jaime Alfaro-Alfaro et al. 2016 |
Copyright_xml | – notice: Copyright © 2016 Jaime Alfaro-Alfaro et al. – notice: Copyright © 2016 Jaime Alfaro-Alfaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. – notice: Copyright © 2016 Jaime Alfaro-Alfaro et al. 2016 |
DBID | ADJCN RHU RHW RHX NPM AAYXX CITATION 3V. 7RV 7X7 7XB 8FI 8FJ 8FK ABUWG AFKRA AZQEC BENPR CCPQU CWDGH DWQXO FYUFA GHDGH K9. KB0 M0S NAPCQ PIMPY PQEST PQQKQ PQUKI PRINS 7X8 5PM DOA |
DOI | 10.1155/2016/4705790 |
DatabaseName | الدوريات العلمية والإحصائية - e-Marefa Academic and Statistical Periodicals Hindawi Publishing Complete Hindawi Publishing Subscription Journals Hindawi Publishing Open Access Journals PubMed CrossRef ProQuest Central (Corporate) ProQuest Nursing and Allied Health Journals Health & Medical Collection ProQuest Central (purchase pre-March 2016) Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central ProQuest Central Essentials ProQuest Central ProQuest One Community College Middle East & Africa Database ProQuest Central Korea Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Database (Alumni Edition) Health & Medical Collection (Alumni Edition) Nursing & Allied Health Premium Publicly Available Content Database ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition ProQuest Central China MEDLINE - Academic PubMed Central (Full Participant titles) DOAJ: Directory of Open Access Journals |
DatabaseTitle | PubMed CrossRef Publicly Available Content Database ProQuest Central Essentials ProQuest One Academic Eastern Edition ProQuest Health & Medical Complete (Alumni) ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest Nursing & Allied Health Source ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest Central China ProQuest Hospital Collection (Alumni) ProQuest Central Nursing & Allied Health Premium ProQuest Health & Medical Complete Health Research Premium Collection Middle East & Africa Database ProQuest One Academic UKI Edition Health and Medicine Complete (Alumni Edition) ProQuest Central Korea ProQuest Nursing & Allied Health Source (Alumni) ProQuest One Academic ProQuest Central (Alumni) MEDLINE - Academic |
DatabaseTitleList | Publicly Available Content Database PubMed CrossRef |
Database_xml | – sequence: 1 dbid: RHX name: Hindawi Publishing Open Access Journals url: http://www.hindawi.com/journals/ sourceTypes: Publisher – sequence: 2 dbid: DOA name: DOAJ: Directory of Open Access Journals url: https://www.doaj.org/ sourceTypes: Open Website – sequence: 3 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 4 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine |
EISSN | 2090-6692 |
Editor | Cosmi, Erich |
Editor_xml | – sequence: 1 givenname: Erich surname: Cosmi fullname: Cosmi, Erich |
EndPage | 4 |
ExternalDocumentID | oai_doaj_org_article_bcd0a1244e204e07908645eb1e6bac2b 4186247621 10_1155_2016_4705790 27668110 1101538 |
Genre | Journal Article |
GroupedDBID | 24P 3V. 4.4 5VS 7RV 7X7 8FI 8FJ AAFWJ AAJEY ABDBF ABUWG ADBBV ADJCN ADRAZ AFKRA AFPKN AHMBA ALIPV ALMA_UNASSIGNED_HOLDINGS AOIJS BAWUL BCNDV BENPR BKEYQ BPHCQ BVXVI CCPQU CWDGH DIK EBS EJD ESX FYUFA GROUPED_DOAJ GX1 H13 HMCUK HYE IAO IHR KQ8 M48 M~E NAPCQ OK1 PGMZT PIMPY PQQKQ PROAC RHX RNS RPM TUS UKHRP RHU RHW ITC NPM AAYXX CITATION 7XB 8FK AZQEC DWQXO K9. PQEST PQUKI PRINS 7X8 5PM |
ID | FETCH-LOGICAL-c3390-7efbf6a2568bf7d2d1c2f3c84538b30953d6e078bdba5a367d85833648698d0c3 |
IEDL.DBID | RPM |
ISSN | 2090-6684 |
IngestDate | Fri Oct 04 13:15:57 EDT 2024 Tue Sep 17 21:21:08 EDT 2024 Fri Aug 16 08:42:08 EDT 2024 Fri Sep 13 05:12:44 EDT 2024 Thu Sep 26 18:31:20 EDT 2024 Sat Sep 28 08:10:25 EDT 2024 Sun Jun 02 18:52:41 EDT 2024 Thu Sep 12 21:23:49 EDT 2024 |
IsDoiOpenAccess | true |
IsOpenAccess | true |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 2016 |
Language | English |
License | This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c3390-7efbf6a2568bf7d2d1c2f3c84538b30953d6e078bdba5a367d85833648698d0c3 |
Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Academic Editor: Erich Cosmi |
ORCID | 0000-0001-6295-7703 |
OpenAccessLink | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030427/ |
PMID | 27668110 |
PQID | 1820549006 |
PQPubID | 1096432 |
PageCount | 4 |
ParticipantIDs | doaj_primary_oai_doaj_org_article_bcd0a1244e204e07908645eb1e6bac2b pubmedcentral_primary_oai_pubmedcentral_nih_gov_5030427 proquest_miscellaneous_1823907487 proquest_journals_1820549006 crossref_primary_10_1155_2016_4705790 pubmed_primary_27668110 hindawi_primary_10_1155_2016_4705790 emarefa_primary_1101538 |
PublicationCentury | 2000 |
PublicationDate | 20160101 |
PublicationDateYYYYMMDD | 2016-01-01 |
PublicationDate_xml | – month: 1 year: 2016 text: 20160101 day: 1 |
PublicationDecade | 2010 |
PublicationPlace | Cairo, Egypt |
PublicationPlace_xml | – name: Cairo, Egypt – name: United States – name: New York |
PublicationTitle | Case reports in obstetrics and gynecology |
PublicationTitleAlternate | Case Rep Obstet Gynecol |
PublicationYear | 2016 |
Publisher | Hindawi Publishing Corporation Hindawi Limited Wiley |
Publisher_xml | – name: Hindawi Publishing Corporation – name: Hindawi Limited – name: Wiley |
References | (3) 2010; 150 (1) 2008; 29 (5) 2012; 207 (7) 2009; 145 (11) 2014; 21 (8) 2015; 37 (13) 2014; 21 US Food and Drug Administration 2014, http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm393576.htm (9) 2014; 10 (14) 2016; 105 (6) 2008; 15 FDA News Release FDA allows marketing of first-of-kind tissue containment system for use with certain laparoscopic power morcellators in select patients 2016, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm494650.htm (2) 2014; 11 (4) 2012; 9 18262143 - J Minim Invasive Gynecol. 2008 Jan-Feb;15(1):44-8 24769447 - J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):951-3 24865630 - J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):517-30 23144639 - Gynecol Surg. 2012 Nov;9(4):365-368 25331441 - Cochrane Database Syst Rev. 2014 Oct 21;(10):CD004638 22386064 - Am J Obstet Gynecol. 2012 Oct;207(4):259-65 26801067 - Fertil Steril. 2016 May;105(5):1369-76 24795546 - Gynecol Surg. 2014;11:105-112 19398260 - Eur J Obstet Gynecol Reprod Biol. 2009 Jul;145(1):14-21 18366893 - G Chir. 2008 Mar;29(3):115-25 20236750 - Eur J Obstet Gynecol Reprod Biol. 2010 Jun;150(2):180-9 25767949 - J Obstet Gynaecol Can. 2015 Feb;37(2):157-81 11 2 3 14 4 15 5 6 7 8 9 |
References_xml | – volume: 145 start-page: 14 issue: 1 year: 2009 end-page: 21 ident: 7 article-title: Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials publication-title: – volume: 105 start-page: 1369 year: 2016 end-page: 1376 ident: 14 article-title: In-bag manual versus uncontained power morcellation for laparoscopic myomectomy: randomized controlled trial publication-title: – volume: 21 start-page: 951 issue: 5 year: 2014 end-page: 953 ident: 13 article-title: In-bag morcellation publication-title: – volume: 21 start-page: 517 issue: 4 year: 2014 end-page: 530 ident: 11 article-title: AAGL practice report: morcellation during uterine tissue extraction publication-title: – volume: 11 start-page: 105 issue: 2 year: 2014 end-page: 112 ident: 2 article-title: A European survey on awareness of post-surgical adhesions among gynaecological surgeons publication-title: – volume: 9 start-page: 365 issue: 4 year: 2012 end-page: 368 ident: 4 article-title: Prevention of adhesions in gynaecological surgery: the 2012 European field guideline publication-title: – volume: 10 year: 2014 ident: 9 article-title: Minimally invasive surgical techniques versus open myomectomy for uterine fibroids publication-title: – volume: 150 start-page: 180 issue: 2 year: 2010 end-page: 189 ident: 3 article-title: Awareness and perception of intra-abdominal adhesions and related consequences: survey of gynaecologists in German hospitals publication-title: – volume: 37 start-page: 157 issue: 2 year: 2015 end-page: 178 ident: 8 article-title: The management of uterine leiomyomas publication-title: – volume: 29 start-page: 115 issue: 3 year: 2008 end-page: 125 ident: 1 article-title: Peritoneal adhesions: pathophysiology publication-title: – volume: 15 start-page: 44 issue: 1 year: 2008 end-page: 48 ident: 6 article-title: Adhesion reformation after laparoscopic adhesiolysis: where, what type, and in whom they are most likely to recur publication-title: – volume: 207 start-page: 259 issue: 4 year: 2012 end-page: 265 ident: 5 article-title: The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: who needs them? publication-title: – ident: 2 doi: 10.1007/s10397-013-0824-2 – ident: 6 doi: 10.1016/j.jmig.2007.09.012 – ident: 14 doi: 10.1016/j.jmig.2014.04.010 – volume: 29 start-page: 115 issue: 3 year: 2008 ident: 1 publication-title: Il Giornale di chirurgia – ident: 9 doi: 10.1002/14651858.cd004638.pub3 – ident: 11 doi: 10.1016/j.jmig.2014.05.010 – ident: 15 doi: 10.1016/j.fertnstert.2015.12.133 – ident: 3 doi: 10.1016/j.ejogrb.2010.02.017 – ident: 5 doi: 10.1016/j.ajog.2012.01.046 – ident: 8 doi: 10.1016/s1701-2163(15)30338-8 – ident: 4 doi: 10.1007/s10397-012-0764-2 – ident: 7 doi: 10.1016/j.ejogrb.2009.03.009 |
SSID | ssj0000602329 |
Score | 1.990906 |
Snippet | Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon... |
SourceID | doaj pubmedcentral proquest crossref pubmed hindawi emarefa |
SourceType | Open Website Open Access Repository Aggregation Database Index Database Publisher |
StartPage | 1 |
SubjectTerms | Case Report |
SummonAdditionalLinks | – databaseName: DOAJ: Directory of Open Access Journals dbid: DOA link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1La9wwEBYlkNJL6btukjKF9Gjila2Hj-mSkJa6LKSB3IxkyexCY4fsps3-pf7KzkjezW4p5NKjLT8kzad5aWbE2CEVZHFC-DSz0qSFFza13NlUtdYoNLaN1pTgXH2TZxfFl0txuXHUF8WExfLAceKObOMyQ0LI86zwmSpRBy8EchgvrWm4Ddx3JDaMqciDURaFI8p4VqJ9JHWxinoXAg3-kTwqFOVhZlvyKJTtD7m5Bq9RVu1OyTL-NfuX_vl3GOWGXDp9xp4OCiUcx4E8Z49894I9roYt85fsN634H_4OvqJYpNKV_fWsgWrZX5G__moJ5ImFc4-Q9nDspp7cZ3OYxIQC72L7hHz2N7Aq-PTTQxWdi3MwnYMJnbUGVR_2AQKt6Q1K8cN2ODeth_G0R54Esw7GMQoBPlOu4YJic5cwRmE6f8UuTk--j8_S4YCGtMlznFblW9tKg1qTtq1y3I0a3uaNLpCL2pwq2TmJJNPWWSNMLpXTlOQlCy1L7bImf812ur7zbxkIZVFQlmivFaihNaZUXHL8mPFa4rtNwj6uyFRfxzocdbBfhKiJnPVAzoR9Ihqun6Hq2eEGYqoeMFU_hKmEvRkQcP8vZF04qoQdDoh4oBf7K7jUA0-Y11QqH61xxGbCPqybcTUH0nS-vw3P5OSu0Ar7ENG1_hFXCGPsR8LUFu62xrrd0s2moWK4oA1wrt79j8nZY09oqNENtc92Fje3_gAVs4V9H9bgH8pvNEo priority: 102 providerName: Directory of Open Access Journals – databaseName: Hindawi Publishing Open Access Journals dbid: RHX link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1Lb9NAEF5BJRAXxBtDQYNUjhbu2vvwsURUAWEUUSrlZu3LSqTWruoUyF_iVzKzdgIpSHB01psde2Z35pvd-czYARGyeCFCmllp0iIIm1rubaoaaxSCbaM1FThXn-T0tPgwF_ORJKn_cwsfvR3C80P5plBUNYnY_KbWRJH_eTrfplJwOIwLKNDlWYlgSOpic8T9Wvcd5xM5-mMhrsFrdEy3FgSDvy3_FmxePzP5mxM6vsfujtEjHA3qvs9uhPYBu12N--MP2Q-a3mfhO3xEH0g8ld3F0kG17s4pOX--Bkq7wklA-w1w5BeBcmU9zIbqgeCH9hkl6C9hw-70NUA1ZBJ7MK2HGX1YDaouJv2jYqkH1fNhO5yYJsBk0eECBMsWJsORA3hPhYUrOoi7hgl6zv4ROz1-92UyTcevMaQuz_G1qtDYRhoMkbRtlOf-0PEmd7rAJdPmRFvnZcCAw3prhMml8poqumShZal95vLHbK_t2vCUgVAWvWKJ4KzAcMyZUnHJ8c9M0BL7uoS93qipvhhIN-oIVoSoSZ31qM6EvSUdbu8hquz4A5pPPc682jqfGYpiAs8KFLBEEFcIdFFBWuO4TdiT0QJ-jYXrFD5Vwg5Gi_iHFPsbc6nHBaCviRcfoTfaZsJebZtx6kbVtKG7ivfklJvQCmUYrGs7EFdoxihHwtSO3e08625Lu1xEenBBu91cPfs_6Z-zO3Q5ZJX22d7q8iq8wDhrZV_GWfYTbK8hTw priority: 102 providerName: Hindawi Publishing – databaseName: Health & Medical Collection dbid: 7X7 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwhV1Zb9NAEF6VIhAvFTcuBS1SebTirr2Hn6oSUQWEUaRSKW_WXm4iUTtN0kL-Un8lM2s7JQjBo7M-ZjPfzrUzs4QcYkMWx7mPEyN0nHluYsOciWVltARnWyuFBc7FVzE6zz5P-GSHjPpaGEyr7GViENSusRgjH2CjcfBlACQDbTAKYFeD4_lVjOdH4T5rd5jGPXL_iIFZAciWE7mJtgBFYDqgLcySHPwlobI-C57zAcOMr0xiXWaypZ9CG_9Qq6vhGnTXgyl6yj9mf7NH_0yr_E1PnT4me52BSU9aRDwhO75-Sh4W3Rb6M3KLEuC7_0m_gJrEVpbNfGZpsW4uMX5_uaYYmaVnHiDu6YmbegynLem4LTDwrh0fYwx_QfsGUDeeFm2wcUl17egYz16jRRP2BQLv8Qks-YNxeqYrT4fTBmQUndV02GYl0E9Ye7jCXN01HYJyXT4n56cfvw1HcXdgQ2zTFP5W6StTCQ1WlDKVdMwdWValVmUgVU2Kne2c8GCTGGc016mQTmHRl8iUyJVLbPqC7NZN7V8RyqUBxZmD_5aBxWZ1Lplg8DLtlYBnbUTe92wq521fjjL4M5yXyM6yY2dEPiAPN_dgN-3wQ7O4KLvFWRrrEo2GjmdJBgTm4OdlHLSYF0ZbZiLyskPA3bdAlMGsInLYIeI_VBz0cCk7GbEs7xAdkXebYVjdgTW1b67DPSmGL5QEGlp0bT7EJMAY6IiI3MLd1ly3R-rZNHQQ57ghzuT-v8l6TR7hJNqA0wHZXS2u_RswwVbmbVhdvwA-WS8u priority: 102 providerName: ProQuest – databaseName: Scholars Portal Open Access Journals dbid: M48 link: http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwjV1Lb9QwELaqIhAXxJuUgoxUjoHU8SsHhMqKqiCCVior9RbZscOu1CZld1u6f4lfyYydLGxVCY6J87A933ge9swQsocJWZwQPs2sNCn3wqaWOZuqxhoFxrbRGgOcy6_yaMI_n4iTLTJUG-0ncHGjaYf1pCbz0zdXP1bvgeHfBYYXAuz3ffmWKwyrBOP9FuM5R6yXvaIf12SQTaFkGcsKsJek5sMp-Gsf2JBPIY1_iNU1cA2y6_YULeWfs5v00evHKv-SU4f3yb1ewaQHEREPyJZvH5I7Zb-F_oj8whXg1F_RLyAmMZVldz6rabnqztB_f7ai6Jmlxx4g7umBm3p0py3oOAYYeBfbx-jDn9MhAdSlp2V0Ni6oaR0dY-01WnZhXyDQHt_AkD9op8em8XQ07WCNorOWjuKpBPoJYw-XeFZ3RUcgXBePyeTw47fRUdoXbEjrPIdpVb6xjTSgRWnbKMfcfs2avNYcVlWbY2Y7Jz3oJNZZI0wuldMY9CW5loV2WZ0_Idtt1_pnhAplQXAWYL9x0NhqUygmGXzMeC3h3TohrwcyVecxL0cV7BkhKiRn1ZMzIR-QhutnMJt2uNHNv1c9c1a2dplBRcezjEMHC7DzuAAp5qU1NbMJedoj4M-_YCmDUSVkr0fEP3qxO8ClGiBeYep8sM4Bmwl5tW4G7g6kaX13EZ7J0X2hFfQhomv9I6YAxtCPhKgN3G2MdbOlnU1DBnGBG-JM7fznJD4nd_Eyep52yfZyfuFfgC62tC8Dm_0Gr2EvSA priority: 102 providerName: Scholars Portal |
Title | Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases |
URI | https://search.emarefa.net/detail/BIM-1101538 https://dx.doi.org/10.1155/2016/4705790 https://www.ncbi.nlm.nih.gov/pubmed/27668110 https://www.proquest.com/docview/1820549006/abstract/ https://search.proquest.com/docview/1823907487 https://pubmed.ncbi.nlm.nih.gov/PMC5030427 https://doaj.org/article/bcd0a1244e204e07908645eb1e6bac2b |
Volume | 2016 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR3LbtNAcNUWgbgg3hjaaJHK0U1iex85tlHbgHAVtVTKzdqXiaXGjpIUyC_xlcys7ZAgJCQuKyXjjXcz79mZWUKOsSGLZcyFPc1VmDimQx1ZHYpcKwHOtpISC5zTKz66TT5N2GSPsLYWxiftG12clHezk7KY-tzK-cx02zyx7jgdMjzPA599n-yLON5y0WvxC2rI304W9QbgGnGZtAnvjIGv3-fdRGAJJl4CFwmA97F8dksr-eb9vkJXwWfQWA-n6B9_L_5mhf6ZTLmlnS6ekieNWUlP6-U_I3uufE4epc3B-QvyE_n-zv2gn0E5YgPLal4Ymq6rGUbtZ2uK8Vh644CwHT21U4dBtCUd12UFztbwMUbuF7Rt-_TN0bQOMS6pKi0d441rNK38aYDHOM7AQj-A0xuVOzqcViCZaFHSYZ2LQD9ixeEKM3TXdAgqdfmS3F6cfxmOwuaahtDEMfzDwuU65wpsJ6lzYSPbN1EeG5mALNUx9rOz3IEloq1WTMVcWImlXjyRfCBtz8SvyEFZle4NoUxoUJcD8NoSsNOMGoiIR_BjykkOc01APrRoyuZ1N47MezGMZYjZrMFsQM4Qh5tnsIe2_6JafM0aSsq0sT2F5o2LegkscADeXcJAdzmulYl0QF43FPD7XSDAYFcBOW4o4h-rOGzJJWskwzLDhvngkwOZBuT9Bgw87VFTuurePxNj0EIKWENNXZsXtRQbELFDdzt73YUAG_m-4Q3bvP3vme_IY9xfHYE6JAerxb07AptspTvAiRPRIQ_Ozq_G1x0f2YDxctKHMU0kjNejScdz6i928jq4 |
link.rule.ids | 230,315,733,786,790,869,870,883,884,891,2115,2236,12083,21416,24346,27957,27958,31754,31755,33779,33780,43345,43840,53827,53829,74102,74659 |
linkProvider | National Library of Medicine |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwhV1Zb9NAEF5BKigviKvFUGCRyqNV197DfkJt1CqFOIpoK_XN2sskErVDnAL5S_xKZuxNShCCR2d9zGa-nWtnZgnZx4YslnMXRlqokDmuQx1bHcpSKwnOtkpTLHDOR2JwyT5c8SsfcGt8WuVKJraC2tYGY-QH2GgcfBkAyfvZ1xBPjcLdVX-Exl2yxRJwVXpk6_hkNP60jrIAJWAyoA0cRxn4SSJlq-x3zsHxPxQHTGI9ZrShl9r2_W2NroJr0Fn3Jughf5_-zQ79M53yN_10-og89IYlPeqQ8JjccdUTcj_3W-dPyU9c-V_cDzoE9YgtLOvZ1NB8WV9j3P56STEiS88dQNvRIztxGEZr6LgrLHC2Gx9j7H5OV42fvjmad0HGhqrK0jGeuUbzut0PaHmOT2CpH4zTc1U62p_UIJvotKL9LhuBnmHN4QJzdJe0D0q1eUYuT08u-oPQH9QQmiSBv1W6UpdCgfWU6lLa2B6auExMykCa6gQ72lnhwBbRViuuEiFtisVegqUiS21kkh3Sq-rKPSeUSw0KMwO_jYGlZlQmYxHDy5RLBTxrAvJuxaZi1vXjKFo_hvMC2Vl4dgbkGHm4vge7aLc_1PPPhV-UhTY2UmjguDhiQGAG_h3joL2c0MrEOiC7HgG33wIRBrMKyL5HxH-o2FvBpfCyoSlukRyQt-thWNUtaypX37T3JBi2SCXQ0KFr_aFYAoyBjoDIDdxtzHVzpJpO2s7hHDfCY_ni32S9IduDi3xYDM9GH1-SBzihLui0R3qL-Y17BWbYQr_2a-0XTyYvxw |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwhV3db9MwELdgiIkXxDcZA4w0HqMGJ7aTJzQK1QbrVGlM6lvkr9BKLOmaDui_xF_JneN0FCF4TJ2Pc-_n-_LdmZADbMhiOXdxooWKM8d1rJnVsay0kuBsqzzHAufxqTg6zz5O-TTkP7UhrbKXiV5Q28ZgjHyAjcbBlwGQDKqQFjF5P3q7uIzxBCncaQ3Hadwkt0BLJniagZzKTbwFaALjAa1hlhTgMYk86_PgOR8wzPnKJFZmJlsayjfy99W6Cq5Be92eoa_8ff43i_TPxMrfNNXoHrkbTEx62GHiPrnh6gdkdxw20R-SnygDvrof9AQUJTazbBZzQ8fr5gIj-BdrirFZeuYA5I4e2pnDgFpLJ12JgbPd-ASj-Evat4D65ui4Cze2VNWWTvD0NTpu_M6A5z4-gUV_ME7PVOXocNaAlKLzmg67vAR6jNWHK8zWXdMhqNf2ETkfffg8PIrDkQ2xSVP4W6WrdCUU2FG5rqRl9o1hVWryDOSqTrG3nRUOrBJtteIqFdLmWPYlslwUuU1M-pjs1E3tnhLKpQbVWYAHl4HNZlQhmWDwMuVyAc-aiLzu2VQuus4cpfdoOC-RnWVgZ0TeIQ8392A_bf9Ds_xShuVZamMThaaOY0kGBBbg6WUc9JgTWhmmI_IkIOD6WyDMYFYROQiI-A8V-z1cyiAl2vIa0xF5tRmG9e1ZU7vmyt-TYgAjl0BDh67Nh5gEGAMdEZFbuNua6_ZIPZ_5HuIct8SZ3Ps3WS_JLiyy8uT49NMzcgfn00Wf9snOannlnoM9ttIv_EL7BYRoMo0 |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Complex+Laparoscopic+Myomectomy+with+Severe+Adhesions+Performed+with+Proper+Preventive+Measures+and+Power+Morcellation+Provides+a+Safe+Choice+in+Certain+Infertility+Cases&rft.jtitle=Case+reports+in+obstetrics+and+gynecology&rft.au=Alfaro-Alfaro%2C+Jaime&rft.au=Flores-Manzur%2C+Mar%C3%ADa+de+los+%C3%81ngeles&rft.au=Nevarez-Bernal%2C+Roberto&rft.au=Ayala-Y%C3%A1%C3%B1ez%2C+Rodrigo&rft.date=2016-01-01&rft.issn=2090-6684&rft.eissn=2090-6692&rft.volume=2016&rft.spage=1&rft.epage=4&rft_id=info:doi/10.1155%2F2016%2F4705790&rft.externalDBID=n%2Fa&rft.externalDocID=10_1155_2016_4705790 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2090-6684&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2090-6684&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2090-6684&client=summon |