Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas

Abstract

Study objective: To compare the postoperative recovery of patients undergoing laparoscopic and minilaparotomic myomectomy.

Design: Randomized study (Canadian Task Force classification I).

Setting: University hospital.

Patients: One hundred forty-eight women requiring surgical myomectomy.

Interventions: Myomectomy by minilaparotomy or laparoscopy.

Measurements and main results: Operation time was significantly lower in the minilaparotomy group (p < .001). When compared with minilaparotomy, laparoscopy was associated with a lower decline of hemoglobin concentration (p <.001), a reduced length of postoperative ileus (p < .001), and a shorter time to discharge (p <.001). Pain intensity at 6 hours after surgery was significantly lower in the laparoscopy group (p <.001); also, patients who underwent laparoscopy requested analgesics less frequently in the first 48 hours after the operation (p < .001). Patients included in the laparoscopy group were fully recuperated on postoperative day 15 more frequently than those included in the minilaparotomy group (p = .012). No complications were observed in the minilaparotomy group. There were two complications in the laparoscopy group (one laparoconversion caused by difficulties of hemostasis and one acute diffuse peritonitis caused by ileal perforation). Laparoscopic and minilaparotomic myomectomy cost, respectively, 2250 euros and 1975 euros.

Conclusion: When compared with minilaparotomic myomectomy, laparoscopic myomectomy may offer the benefits of lower postoperative analgesic use and faster postoperative recovery.