title: Laparoscopic myomectomy for very large myomas using an isobaric (gasless) technique.
abstract: OBJECTIVE
  Laparoscopic myomectomy using pneumoperitoneum for large myomas (> or = 8 cm) is hindered by several factors, such as the increased operative time, the risk of perioperative bleeding, and the risk of conversion to laparotomy. With the introduction of isobaric laparoscopy using abdominal wall lifting, this procedure can be performed using conventional surgical instruments introduced through small abdominal incisions. The aim of this study was to evaluate the feasibility, reproducibility, and safety of isobaric laparoscopic myomectomy for very large myomas > or = 10 cm using a subcutaneous abdominal wall-lifting device.
  
  
  METHODS
  A series of 24 consecutive patients with at least 1 symptomatic myoma > or = 10 cm underwent a gasless laparoscopic myomectomy with the Laparotenser device. Conventional long laparotomy instruments were used.
  
  
  RESULTS
  Gasless laparoscopic myomectomy was successful in all 24 consecutive patients. The size of the dominant myoma varied from 10 cm to 20 cm. The median operating time was 93 minutes. The median postoperative drop in hemoglobin was 2.8 g/dL. No surgical complications occurred. The median hospital stay was 2.8 days.
  
  
  CONCLUSIONS
  Gasless laparoscopic myomectomy is feasible, reproducible, and safe for removing very large myomas. Therefore, it can represent an excellent option for the minimally invasive removal of very large myomas.
authors.affiliation: Unit of Gynecology and Obstetrics, International School of Gynaecological Endoscopy, S Pio X Hospital, Milan, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Damiani
authors.forename: Luigi
authors.initials: L
authors.lastname: Melgrati
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marziali
authors.forename: Francesco
authors.initials: F
authors.lastname: Sesti
authors.forename: Emilio
authors.initials: E
authors.lastname: Piccione
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D014594:Uterine Neoplasms / Q000601:surgery*