Experience with laparoscopic leiomyoma coagulation and concomitant operative hysteroscopy.
OBJECTIVE
To evaluate the experiences of women who underwent laparoscopic leiomyoma coagulation (myolysis) alone and those who had myolysis in conjunction with transcervical endomyometrial resection (TEMR), transcervical electrosurgical resection of submucous leiomyomas (TSR), or both.


METHODS
Continuing, prospective observational study with mean (+/- SEM) follow-up of 36.0 +/- 1.2 months (range 18-54 mo).


METHODS
Gynecology department of community and teaching hospitals.


METHODS
One hundred sixty-seven women with symptomatic leiomyomata.


METHODS
Women complaining of pressure, pain, or both underwent only myolysis. Those with the additional symptom of chronic menorrhagia underwent TEMR, TSR, or both. Nineteen (11.4%) of the 167 women had elective second-look laparoscopy 6.0 +/- 0.3 months (range 6-8 mo) later to evaluate possible adhesion formation.


RESULTS
Main outcome measures were control of symptoms, numbers and types of concomitant and subsequent procedures, changes in uterine and leiomyomata volumes, and number of successful pregnancies. Mean total uterine volume of the 167 women decreased from 620 +/- 28.4 cm3 before leuprolide treatment to 131 +/- 7.2 cm3 by 7 to 12 months postoperatively (p <0.0001). Five (3.6%) women had hysterectomies for persistent or recurrent menorrhagia, pain, pressure, or a combination of symptoms (p = 0.01). Pathologic evaluation revealed adenomyosis, leiomyomata, or both. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea and 17 (32.7%) developed hypomenorrhea or eumenorrhea; 2 (3.8%) required repeat TEMR. The two women who desired to retain fertility had uncomplicated full-term pregnancies and uneventful vaginal deliveries.


CONCLUSIONS
Myolysis alone or in conjunction with TEMR, TSR, or both obviated the need for major surgery in 162 (97.0%) women. Until further studies are concluded, myolysis should be performed selectively in women contemplating pregnancy.
Phillips
D R
DR
Department of Obstetrics and Gynecology, South Nassau Communities Hospital, Oceanside, New York, USA.
Milim
S J
SJ
Nathanson
H G
HG
Haselkorn
J S
JS
D000328:Adult; D004598:Electrosurgery; D004717:Endometrium / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D015907:Hysteroscopy; D010535:Laparoscopy / Q000009:adverse effects; D017075:Laser Coagulation / Q000009:adverse effects; D007889:Leiomyoma / Q000601:surgery*; D009215:Myometrium / Q000601:surgery; D011183:Postoperative Complications; D011247:Pregnancy; D011300:Preoperative Care; D011446:Prospective Studies; D012086:Reoperation; D000267:Tissue Adhesions; D014594:Uterine Neoplasms / Q000601:surgery*