Laparoscopic myomectomy

Abstract

Objective: To investigate the indications, surgical techniques and complications of laparoscopic myomectomy.

Materials and methods: A retrospective study was carried out in 74 patients with fibroids > 3 cm from March, 1995 until May, 2000 at PUMC Hospital. Indications for surgery were symptomatic fibroids (20 cases), mainly pain or urine frequency; progressively increasing fibroid size (7 cases); coexistent adnexal pathology(26 cases) and infertility(21 cases).

Results: The number of fibroids of each patient varied from 1 to 4 with single fibroid of 62 cases (83.7%). The fibroids were located in anterior wall (30 cases), posterior wall (23 cases) and fundus (21 cases). A total of 93 fibroids were removed from these patients including 16 intramural fibroids and 77 subserous fibroids. The size of dominant fibroids ranged from 3 approximately 8 cm (mean 4.8 cm). In 19 cases (25.6%), the uterine wall was sutured in one layer. Mean duration of operation was 73 minutes and mean blood loss was 82 ml. Longer operating time and more blood loss were observed in patients with fibroids > or = 4 cm than those with fibroids < 4 cm. The difference was statistically significant ( P < 0.05). Mean postoperative hospital stay was 3.2 days and overall complication rate was 1.4%. The average postoperative follow-up period was 22 months (1 approximately 62 months). All the patients with symptoms showed remission of their complaints at 2-month follow-up. Recurrence of fibroid occurred in 1 case 1 year after initial operation and second laparoscopic myomectomy was given to her successfully. Five patients became pregnant. The pregnancy was uneventful and proceeded to selective caesarean section at term pregnancy in 4 cases. One miscarriage occured at 8 weeks in the 5th case. No adhesions at myomectomy site were found in these 5 patients.

Conclusions: Our study suggests the feasibility of laparoscopic myomectomy in selected patients, which leads to effectiveness, low complication rate and satisfactory remission of symptoms. Further study on recurrence and fertility must be continued.