Laparoscopic myomectomy for large myomas

Abstract

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9 +/- 5.6 yr, mean parity was 0.6 +/- 0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6 +/- 38.9 min, and the mean diameter of the largest myoma was 9.3 +/- 1.8 cm. The mean change in hemoglobin concentration was 2.1 +/- 1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.

Fig. 1

(A) Port placement system of laparoscopic myomectomy for large myomas. (B) New metallic screw.

Fig. 2

(A) Intramural myoma of 9 cm in diameter on the posterior uterine wall on ultrasonography. (B) An image of a new metallic screw fixed to the myoma after peeling off the capsule of the myoma. (C) An image of the uterus after laparoscopic myomectomy.

Fig. 3

Comparison between this study and the previous studies in myoma size (A), operating time (B), hemoglobin change (C), and ratio with complication (D).