Supplementary Material for: Ulipristal Acetate before Hysteroscopic and Laparoscopic Surgery for Uterine Myomas: Help or Hindrance?

<b><i>Background/aims:</i></b> Ulipristal acetate ([UPA], Esmya®) is an orally active selective progesterone-receptor modulator that has been approved as preoperative treatment for uterine myomas. This systematic review aims to summarize the available data on surgical outcomes of patients undergoing myomectomy by hysteroscopy or by laparoscopy after preoperative treatment with UPA. <b><i>Methods:</i></b> this review was performed following PRISMA guidelines and was registered in PROSPERO (CRD42018092201). PubMed, EMBASE, and Medline databases were systematically searched electronically until March 2018 for keywords concerning this topic. There were included only peer-reviewed, English language journal articles. <b><i>Results:</i></b> two prospective studies and 4 retrospective studies were included. The effect of UPA on the endometrium does not increase the technical difficulty during hysteroscopic myomectomy, but it increases the chance of complete primary resection in complex hysteroscopic myomectomies. Moreover, UPA does not increase the overall technical difficulty of laparoscopic myomectomy. Contradictory results have been reported on the impact of UPA on the separation of the myoma from the myometrium and on the consistency of the myomas. <b><i>Conclusion:</i></b> current results support the use of UPA prior to both surgical procedures. Further studies should confirm these preliminary findings and to assess the long-term outcomes of myomectomies following UPA treatment.

背景与目的：醋酸乌利司他（Ulipristal acetate, UPA，商品名Esmya®）是一种口服活性选择性孕激素受体调节剂，已被批准用于子宫肌瘤的术前治疗。本系统综述旨在总结术前接受UPA治疗后，经宫腔镜或腹腔镜行子宫肌瘤切除术患者的手术结局相关现有数据。方法：本综述遵循PRISMA（Preferred Reporting Items for Systematic Reviews and Meta-Analyses）指南开展，并已在PROSPERO（国际前瞻性系统综述注册平台）注册，注册号为CRD42018092201。截至2018年3月，通过电子系统检索PubMed、EMBASE及Medline数据库，使用与本主题相关的关键词进行文献筛选。仅纳入经同行评议的英文期刊论文。结果：共纳入2项前瞻性研究与4项回顾性研究。UPA对子宫内膜的影响并未增加宫腔镜子宫肌瘤切除术的手术操作难度，却可提升复杂性宫腔镜子宫肌瘤切除术的首次完整切除成功率。此外，UPA并未增加腹腔镜子宫肌瘤切除术的整体操作难度。针对UPA对肌瘤与子宫肌层分离效果及肌瘤质地的影响，现有研究结果存在矛盾。结论：现有研究结果支持在上述两种手术方式术前使用UPA。未来需开展更多研究以验证这些初步发现，并评估UPA治疗后子宫肌瘤切除术的长期临床结局。