Laparoscopic myomectomy: indications, surgical technique and complications.
The indications and complications of laparoscopic myomectomy were evaluated with regard to its limitations, benefits and feasibility. Surgical technique with related difficulty was also reported. From a population of 89 patients, a total of 104 myomas were removed laparoscopically. A retrospective study was carried out of 54 patients with myomas >3 cm. Indications for surgery were pain or abnormal bleeding (37%), increase in size of the myoma in infertile patients (48.1%) and infertility requiring assisted reproductive technology (14.9%). A total of 57 myomas >3 cm were removed from these patients. The number of myomas per patient varied from 1 to 4. The myomas were intramural (n = 34), subserosal (n = 19) and submucosal (n = 4). The size of the dominant myoma ranged from 3-8 cm (mean 4.16). In all cases the uterine wall was sutured either in one (n = 42) or two planes (n = 15) depending on the depth of the myometrial defect. The laparotomy conversion rate was 1.8% (n = 1); mean blood loss was 84 ml; average hospital stay was 2.09 days and the overall complication rate was 1.8%. Five patients went on to conceive; the pregnancy was uneventful and proceeded to Caesarean section at 38 weeks. No adhesions at myomectomy sites were observed in these patients. At 6 months follow-up, 18 out of 20 patients with pain or haemorrhagic disorders prior to surgery showed remission of their complaints. Our study confirms the feasibility of laparoscopic myomectomy as a technique leading to a low complication rate and remission of symptoms. At the present time, statistically significant data concerning post-surgical adhesion formation or pregnancy outcome are not available.
Seinera
P
P
Department of Obstetrics and Gynaecology, University of Turin, S.Anna Hospital, Italy.
Arisio
R
R
Decko
A
A
Farina
C
C
Crana
F
F
D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects; D007889:Leiomyoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010146:Pain / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D013537:Sutures; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*