Strategy of cervical myomectomy under laparoscopy

Abstract

Objective: To evaluate a strategy of laparoscopic excision of a cervical myoma (CM).

Design: Prospective study.

Setting: University-affiliated hospital.

Patient(s): Twenty-eight patients with CM underwent laparoscopic myomectomy. These cases were classified into five types according to the location: [1] anterior cervical myoma (ACM); [2] posterior cervical myoma (PCM); [3] central cervical myoma (CCM); [4] lateral cervical myoma [LCM]; and [5] deep-rooted cervical myoma (DCM).

Intervention(s): After preoperative assessment, patients underwent laparoscopic myomectomy. Ligation of the uterine artery and diluted vasopressin injection were performed to decrease bleeding during laparoscopy.

Main outcome measure(s): Myoma numbers, myoma weight, operative time, estimated blood loss, hospital stay, complication rate.

Result(s): Most of the lesions were ACM (43%) and PCM (32%). The mean operative time was 121 minutes, mean blood loss was 99 mL, and mean myoma weight was 287 g. The mean hospital stay was 2.2 days. There were no complications. Histopathologic examination showed that all lesions were leiomyoma. Hypermenorrhea, dysmenorrhea, and symptoms of compression improved after the operation. Two infertile patients conceived spontaneously at 1 and 7 months postoperatively, and successfully delivered infants by cesarean section at term.

Conclusion(s): Surgical treatment of CM is empirically difficult. It is important that the approach be changed according to the location and size of the myoma.