A retrospective multicentre study comparing myomectomy by laparoscopy and laparotomy in current surgical practice. What are the best patient selection criteria?

Abstract

Objective: To determine the differences in myoma characteristics before laparoscopic myomectomy (LM) and abdominal myomectomy (AM) and to compare outcomes in current practice.

Study design: We analysed retrospectively the data for 126 LMs and 176 AMs performed between January 1996 and January 2000 in 11 centres. Myomas were examined by transvaginal B-mode, colour and pulsed energy Doppler ultrasonography. The following data were collated: (i) pre-operative: myoma size, number, type and location and medical treatment, (ii) per-operative: operator, blood loss, surgical procedure and operative time, and (iii) post-operative: myoma weight and number, haemoglobin decrease, complications and length of hospital stay.

Results: Compared to women undergoing LM, women undergoing AM had more myomas that were larger and that were generally interstitial and anterior. More of them received GnRH analogues. Excised myomas weighed four times more, the decrease in haemoglobin was greater (1g/dl), fever was more frequent, and nine patients needed transfusions (compared to none for LM). There were 37 laparoconversions (29%) after LM. The conversion rate was high for inexperienced surgeons. Length of hospital stay was reduced by half for LM (without laparoconversion). Recurrence rate at 2 years was 2.5% for LM versus 3.6% for AM (P = 0.506).

Conclusion: Pre-operative evaluation by ultrasound is essential to establish myoma number, size, type and location in order to choose the most appropriate surgical procedure.