Comparison of laparoscopic myomectomy using in situ morcellation with and without uterine artery ligation for treatment of symptomatic myomas.
OBJECTIVE
To evaluate the efficacy of laparoscopic uterine artery ligation (LUAL) before in situ morcellation (ISM) compared with ISM alone.


METHODS
Prospective study (Canadian Task Force classification II-1).


METHODS
University-affiliated hospital.


METHODS
One hundred forty-four women with symptomatic uterine myomas, of whom 45 underwent LUAL and ISM and 99 underwent ISM only, from August 2007 through August 2009.


METHODS
Ligation or no ligation of the uterine arteries before ISM.


RESULTS
In the LUAL+ISM group compared with the ISM group, mean (SD) operative time was significantly longer (107 [34] minutes vs 93 [35] minutes; p = .03), and there was less intraoperative blood loss (84 [53] mL vs 137 [166] mL; p < .001). Eight patients in the ISM group (8.1%) required a blood transfusion, including 4 (4.0%) with excessive intraoperative bleeding and 4 (4.0%) with postoperative hematomas. Although myomas in the LUAL+ISM group weighed more (p < .001), none of the patients in that group had excessive intraoperative bleeding, postoperative hematomas, or required blood transfusion (p = .046). At 2 years of follow-up, in the LUAL+ISM group compared with the ISM group, the myoma recurrence rate was 7% vs 24%, and symptom improvement was reported by 98% of patients vs 86% (statistically significant).


CONCLUSIONS
Laparoscopic myomectomy using an ISM technique with or without simultaneous LUAL may be used in the management of symptomatic uterine myomas; however, LUAL+ISM may result in a better surgical outcome.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Wen-Chun
WC
Chang
Pei-Shen
PS
Huang
Peng-Hui
PH
Wang
Daw-Yuan
DY
Chang
Su-Cheng
SC
Huang
Szu-Yu
SY
Chen
Li-Yun
LY
Chou
Bor-Ching
BC
Sheu
D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D001810:Blood Volume; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D008026:Ligation; D008875:Middle Aged; D061646:Operative Time; D012008:Recurrence; D055988:Uterine Artery / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*; D055815:Young Adult