Case-control study of laparoscopic versus abdominal myomectomy.
OBJECTIVE
To compare laparoscopic with abdominal approaches to myomectomy.


METHODS
Frequency matching was used to ensure similar fibroid weights among the laparoscopic and abdominal groups in this case-control study. The study group consisted of prospectively recruited patients undergoing laparoscopic (N = 5) or laparoscopically assisted (N = 20) myomectomy (lap). The control group represented both prospectively (N = 14) and retrospectively (N = 37) identified abdominal myomectomy patients (abd). Analysis of the variables was performed using a t-test, Wilcoxon rank-sum test, chi-square test, or analysis of covariance at the 0.01 significance level.


RESULTS
All results are reported after matching for fibroid weight, with the median (quartiles) aggregate weight measuring 151 g (31.0, 262.0) and 170.0 g (81.0, 285.0) for the lap and abd patients, respectively (P = 0.15). Median (quartiles) length of hospital stay (30.5 hours [25.0, 52.5] v 65.0 hours [45.0, 76.0]; P < 0.001) and duration of postoperative intravenous narcotic use (14.8 hours [3.0, 18.5] v 24.0 hours [18.0, 40.0]; P = 0.001) were significantly shorter for the lap patients. The laparoscopic cases required a longer median operative time (222.5 minutes [192.5, 270.0]) than the abdominal cases (180.0 minutes [160.0, 220.0]; P = 0.001). No difference was detected in estimated blood loss from surgery (P = 0.57).


CONCLUSIONS
A laparoscopic approach to myomectomy may be safely chosen for patients with fibroids and offers the benefits of less postoperative intravenous narcotic use, a shorter hospital stay, and no greater intraoperative blood loss than abdominal myomectomy.
Silva
B A
BA
Department of Gynecology & Obstetrics and Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio 44195, USA.
Falcone
T
T
Bradley
L
L
Goldberg
J M
JM
Mascha
E
E
Lindsey
R
R
Stevens
L
L
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007889:Leiomyoma / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*