title: Minilaparotomic myomectomy for large symptomatic uterine myomas: a prospective study.
abstract: OBJECTIVE
  The aim of this paper was to evaluate the feasibility, morbidity, and reproductive performance of fertile women undergoing minilaparotomic myomectomy for large uterine myomas.
  
  
  METHODS
  Ninety-nine consecutive women with symptomatic myomas underwent myomectomy through a skin incision ≤8 cm. Operative, postoperative and reproductive data were prospectively collected.
  
  
  RESULTS
  Median (range) age and Body Mass Index (BMI) were 37 years (23-44) and 23 (18-43), respectively. Median (range) myoma diameter was 7 cm (4-20), and the median number of myomas removed was 1 (range 1-31). Myomas were intramural in 76 (76%) cases. Median incision length was 7 cm (range 4-13) and median duration of surgery was 70 min (range 40-180). Operative time and length of skin incision were not correlated with the progressive number of interventions. An incision larger than 8 cm was necessary in 7 (7%) patients and the length of incision was significantly correlated with the diameter of the largest myoma (P<0.01). The feasibility of minilaparotomy was significantly reduced when the diameter of the largest myoma was >12 cm (P<0.05). Operative time was significantly longer in patients having >1 myoma (P<0.05). Three (3%) patients underwent blood transfusion. Median (range) postoperative stay was 2 days (range 2-12). Fever occurred in 8 (8%) patients, and wound complications in 5 (5%).
  
  
  CONCLUSIONS
  Myomectomy by minilaparotomy is a feasible procedure in more than 90% of unselected patients with large symptomatic myomas. Feasibility is questionable when the myoma is >12 cm. This technique is a mini-invasive option to treat patients with large and multiple myomas.
authors.affiliation: Department of Gynecology and Obstetrics, S. Maria Goretti Hospital, Latina, Italy. francesco.maneschi@tin.it
authors.forename: F
authors.initials: F
authors.lastname: Maneschi
authors.forename: I
authors.initials: I
authors.lastname: Ceccacci
authors.forename: A
authors.initials: A
authors.lastname: Vestri
authors.forename: C
authors.initials: C
authors.lastname: Pane
authors.forename: A
authors.initials: A
authors.lastname: Simeone
authors.forename: A
authors.initials: A
authors.lastname: Perugini
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007813:Laparotomy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult