Efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas.
OBJECTIVE
To evaluate the therapeutic efficacy of laparoscopic uterine artery occlusion combined with myomectomy through a minilaparotomy in the treatment of recurrent uterine myomas, compared with myomectomy alone.


METHODS
Controlled, nonrandomized clinical study.


METHODS
University-affiliated tertiary care referral center.


METHODS
Eighty-two women with symptomatic, recurrent myomas warranting surgical treatment, who expressed a strong desire to retain their uterus. Fifty-two patients (63.4%) underwent laparoscopic uterine artery occlusion and subsequent minilaparotomy and myomectomy (group I) and 30 patients (36.6%) underwent myomectomy alone (group II).


METHODS
Occlusion of the uterine arteries was performed with a laparoscopic approach before minilaparotomy and myomectomy.


METHODS
The efficacy of combined laparoscopic uterine artery occlusion and myomectomy via minilaparotomy in the treatment of recurrent uterine myomas was measured by comparing blood loss, need for blood transfusion, postoperative febrile morbidity, recurrence rate of the uterine myomas, and fertility rate in the treatment (group I) and control (group II) groups.


RESULTS
The average blood loss was 125 +/- 72.6 and 550 +/- 394.8 mL in groups I and II, respectively. The recurrence rate of uterine myomas was 5.8% (3 of 52) in group I and 36.7% (11 of 30) in group II during an average follow-up period of 42.5 months. Of the sexually active patients who did not use contraception, 19.2% (5 of 26) and 22.4% (4 of 18) became pregnant in groups I and II, respectively (no statistical significance).


CONCLUSIONS
This study has demonstrated the superiority of laparoscopic uterine artery occlusion when combined with repeat myomectomy in treating recurrent symptomatic myomas.
Liu
Wei-Min
WM
Department of Obstetrics and Gynecology, Taipei Medical University Hospital, and Taipei Medical University, Taipei, Taiwan. weiminliu50@hotmail.com <weiminliu50@hotmail.com>
Wang
Peng-Hui
PH
Chou
Chun-Shan
CS
Tang
Wun-Long
WL
Wang
I-Te
IT
Tzeng
Chii-Ruey
CR
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000098:blood supply* / Q000601:surgery*