title: Comparison of Laparoscopic Myomectomy in Large Myomas With and Without Leuprolide Acetate.
abstract: OBJECTIVE
  To evaluate the efficacy of gonadotropin-releasing hormone analogue (GnRHa) use before laparoscopic myomectomy (LM) in large myomas.
  
  
  METHODS
  Prospective study (Canadian Task Force classification II-1).
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Ninety-one women with large myomas (≥10 cm) or more than 2 myomas ≥ 5 cm underwent LM between July 2011 and March 2014.
  
  
  METHODS
  Forty patients underwent LM after GnRHa use (group A) and 51 underwent LM only (group B). GnRHa was used for 3 doses every 4 weeks before LM in group A.
  
  
  RESULTS
  Group A had a significantly smaller maximum diameter of the largest myoma than group B (8.5 ± 2.1 vs 10.7 ± 2.4, p < .001) and fewer patients with myomas larger than 10 cm after GnRHa administration (33% vs 67%, p = .001). In group A, there was a decrease in 2 or more myomas ≥ 5 cm (20% vs 50%) after GnRHa use. Group A also had significantly smaller mean myoma weight (448 vs 567 g, p = .045) and significantly shorter mean operative time (129 ± 30 vs 152 ± 34 minutes, p = .001). Most patients in group A (40%) had an operative time < 119 minutes, whereas most patients in group B (37%) had an operative time between 150 and 179 minutes. Group A also had less intraoperative blood loss (84 ± 53 vs 137 ± 166 mL, p < .001), drop in hemoglobin (1.5 ± 0.8 vs 3.0 ± 1.7 g/dl, p < .001), excessive bleeding (5% vs 33%, p = .001), postoperative hematoma (2.5% vs 9.8%, p = .168), and blood transfusion (7.5% vs 35%, p = .001).
  
  
  CONCLUSIONS
  GnRHa before LM in large myomas may be an effective adjuvant treatment for women with large and multiple myomas. This method is beneficial in decreasing operative time, intraoperative bleeding, postoperative hemorrhage, and need of blood transfusion.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ling-Hui
authors.initials: LH
authors.lastname: Chu
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu-Chi General Hospital, Taipei, Taiwan.
authors.forename: Pei-Shen
authors.initials: PS
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu-Chi General Hospital, Taipei, Taiwan.
authors.forename: Su-Cheng
authors.initials: SC
authors.lastname: Huang
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: p91421014@ntu.edu.tw.
authors.forename: Bor-Ching
authors.initials: BC
authors.lastname: Sheu
mesh_terms: D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D016729:Leuprolide / Q000008:administration & dosage*; D008875:Middle Aged; D061646:Operative Time; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide
keywords: Gonadotropin-releasing hormone analogue; In situ morcellation; Laparoscopic myomectomy; Large myomas; Sarcoma