Human Reproduction, Vol 12, 1927-1930, Copyright © 1997 by Oxford University Press
P Seinera, R Arisio, A Decko, C Farina and F Crana
The indications and complications of laparoscopic myomectomy were evaluated
with regard to its limitations, benefits and feasibility. Surgical
technique with related difficulty was also reported. From a population of
89 patients, a total of 104 myomas were removed laparoscopically. A
retrospective study was carried out of 54 patients with myomas >3 cm.
Indications for surgery were pain or abnormal bleeding (37%), increase in
size of the myoma in infertile patients (48.1%) and infertility requiring
assisted reproductive technology (14.9%). A total of 57 myomas >3 cm
were removed from these patients. The number of myomas per patient varied
from 1 to 4. The myomas were intramural (n = 34), subserosal (n = 19) and
submucosal (n = 4). The size of the dominant myoma ranged from 3-8 cm (mean
4.16). In all cases the uterine wall was sutured either in one (n = 42) or
two planes (n = 15) depending on the depth of the myometrial defect. The
laparotomy conversion rate was 1.8% (n = 1); mean blood loss was 84 ml;
average hospital stay was 2.09 days and the overall complication rate was
1.8%. Five patients went on to conceive; the pregnancy was uneventful and
proceeded to Caesarean section at 38 weeks. No adhesions at myomectomy
sites were observed in these patients. At 6 months follow-up, 18 out of 20
patients with pain or haemorrhagic disorders prior to surgery showed
remission of their complaints. Our study confirms the feasibility of
laparoscopic myomectomy as a technique leading to a low complication rate
and remission of symptoms. At the present time, statistically significant
data concerning post-surgical adhesion formation or pregnancy outcome are
not available.
ARTICLES
Laparoscopic myomectomy: indications, surgical technique and complications
Department of Obstetrics and Gynaecology, University of Turin, S.Anna Hospital, Italy.
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