title: Simultaneous laparoscopic uterine artery ligation and laparoscopic myomectomy for symptomatic uterine myomas with and without in situ morcellation.
abstract: BACKGROUND
  To determine the optimal surgical approach for laparoscopic uterine artery ligation (LUAL) combined with myomectomy in the management of women with symptomatic uterine fibroids.
  
  
  METHODS
  This is a prospective study. One hundred and six women with symptomatic uterine myomas underwent LUAL + laparoscopic morcellation after enucleation (enucleation group) (n = 51) or LUAL + laparoscopic in situ morcellation (ISM group) (n = 55). The outcome was measured by comparing surgical techniques, symptom control, recurrence and pregnancy during a 3-year follow-up in both groups.
  
  
  RESULTS
  General characteristics of the patients were similar in both groups, except the myomas were larger in the ISM group. The operative time (mean ± SD) was significantly shorter in the ISM group than the enucleation group (107 ± 30 min versus 128 ± 49 min, P = 0.009). There were no differences in the therapeutic outcomes of the two groups at the 3-year follow-up, with low recurrence rates and good symptom control rates. Of the sexually active patients without contraception, the pregnancy and live birth rates were 87.5 and 100% in the ISM group and 66.7 and 83.3% in the enucleation group (all NS).
  
  
  CONCLUSIONS
  The LUAL + myomectomy, either by enucleation or ISM, is acceptable in the management of symptomatic uterine fibroids. However, the LUAL + ISM technique might be more feasible, as it requires less operative time.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine,Taipei, Taiwan.
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Li-Yun
authors.initials: LY
authors.lastname: Chou
authors.forename: Daw-Yuan
authors.initials: DY
authors.lastname: Chang
authors.forename: Pei-Shen
authors.initials: PS
authors.lastname: Huang
authors.forename: Su-Cheng
authors.initials: SC
authors.lastname: Huang
authors.forename: Szu-Yu
authors.initials: SY
authors.lastname: Chen
authors.forename: Bor-Ching
authors.initials: BC
authors.lastname: Sheu
mesh_terms: D000328:Adult; D001723:Birth Rate; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008026:Ligation / Q000009:adverse effects; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D016896:Treatment Outcome; D055988:Uterine Artery / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*