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.

<b><i>背景/目的：</i></b> 醋酸乌利司他（Ulipristal acetate，UPA，Esmya®）是一种口服活性的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，行经宫腔镜子宫肌瘤切除术或腹腔镜子宫肌瘤切除术患者的手术结局相关现有数据。<b><i>方法：</i></b> 本综述遵循PRISMA指南开展，并已在PROSPERO平台注册（CRD42018092201）。研究人员于2018年3月前，系统电子检索PubMed、EMBASE及Medline数据库，使用与本主题相关的关键词进行检索。本综述仅纳入经同行评议的英文期刊论文。<b><i>结果：</i></b> 本综述共纳入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。目前关于UPA对肌瘤与子宫肌层分离的影响及肌瘤质地的相关研究结果存在矛盾。<b><i>结论：</i></b> 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结局。