Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients

Abstract

Study objective: To review surgical outcomes and histopathological findings after laparoscopic myomectomy by a team at a university teaching hospital.

Design: This was a retrospective review of consecutive cases of laparoscopic myomectomy performed by members of our minimal access surgery team between January 2004 and December 2015 (Canadian Task Force classification II-3).

Setting: A university teaching hospital.

Patients: Women undergoing laparoscopic myomectomy.

Interventions: Laparoscopic myomectomy.

Measurements and main results: We collected women's demographic data, clinical histories, and surgical outcomes, including complication rates and the incidence of undiagnosed uterine malignancy. Five hundred fourteen women were booked for laparoscopic myomectomy during the study period. Five hundred twelve of 514 (99.6%; 95% confidence interval [CI], 99.05-100.00) procedures were successfully completed. Two cases were converted to open surgery: one because of suspected uterine malignancy and another because of bowel injury at initial entry. The median number of myomas removed at laparoscopy was 1 (range, 1-12; mode = 1). The median size of the largest myoma removed at each procedure was 70 mm (range, 10-200 mm) as assessed subjectively by the operating surgeon. The median blood loss was 73 mL (range, 5-3000 mL). The median length of stay in the hospital was 2 nights (range, 0-24 nights). Breach of the uterine cavity occurred in 50 of 514 (9.7%; 95% CI, 7.17-12.29) cases. Electromechanical morcellation was used in 496 of 514 (96.5%; 95% CI, 94.9-98.1) patients. Eighteen of 514 (3.5%; 95% CI, 1.91-5.09) women suffered significant complications including blood loss >1000 mL (n = 15), bowel injury (n = 1), bladder injury (n = 1), and small bowel obstruction secondary to port site hernia (n = 1). There were no cases of undiagnosed uterine malignancies after myoma morcellation.

Conclusion: Laparoscopic myomectomy can be conducted with a low rate of major complications, and, in our experience, the chance of discovering occult malignancy is very low.

Keywords: Laparoscopic myomectomy; Laparoscopy; Leiomyoma; Morcellation; Myomectomy.