Abstract
Purpose
Comparison between laparoscopically assisted myomectomy (LAM) and abdominal myomectomy (laparotomy), used in the management of women with intramural or subserous uterine fibroids up to 90 mm of maximum diameter.
Methods
Seventy-five premenopausal women were prospectively enrolled in the study, managed by LAM (n = 48) or by laparotomy (n = 27) approach. The short-term outcomes were compared between the two groups. The patient characteristics were also analyzed.
Results
The mean (±SD) estimated blood loss was significantly less in the LAM procedure compared with laparotomy (246 ± 161 vs. 351 ± 219 ml, respectively, P = 0.03). Similarly, the operative time was shorter in the LAM modality compared with laparotomy (68 ± 21 vs. 83 ± 24 min, respectively, P = 0.01). Intraoperative and postoperative complications were not different between the two groups. The mean days of the bowel reactivity (1.04 ± 0.2) was faster (P < 0.0001), while the duration of hospitalization (1.2 ± 0.6) was shorter (P < 0.0001) in the LAM technique, when compared with abdominal myomectomy (1.8 ± 0.5 and 4.2 ± 0.8, respectively).
Conclusions
In selected group of patients, LAM as minimally invasive approach is an attractive alternative to conventional laparotomic myomectomy, offering significant advantages.
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References
Cramer DW (1992) Epidemiology of myomas. Semin Reprod Endocrinol 10:320–324
Cramer SF, Patel A (1990) The frequency of uterine leiomyoma. Am J Clin Pathol 94:435–438
Babaknia A, Rock JA, Jones HW (1978) Pregnancy success following abdominal myomectomy for infertility. Fertil Steril 30:644–649
Shozu M, Murakami K, Inoue M (2004) Aromatase and leiomyoma of the uterus. Semin Reprod Med 22:51–60
Varelas FK, Papanikolaou AN, Vavatsi-Christaki N, Makedos GA, Vlassis GD (2007) The effect of anastazole on symptomatic uterine leiomyomata. Obstet Gynecol 110:643–649
Steinauer J, Pritts EA, Jackson R, Jacoby AF (2004) Systematic review of mifepristone for the treatment of the uterine leiomyomata. Obstet Gynecol 103:1331–1336
Lethaby A, Vollenhoven B, Sowter M (2002) Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine fibroids undergoing hysterectomy or myomectomy: a systematic review. BJOG 109:1077–1080
Friedman AJ, Daly M, Juneau-Norcross M, Fine C, Rein MS (1992) Recurrence of myomas after myomectomy in women pretreated with leuprolide acetate depot or placebo. Fertil Steril 58:205–208
Hehenkamp WJ, Volkers NA, Donderwinkel PF et al (2005) Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 193:1618–1629
Walker WJ, Pelage JP (2002) Uterine artery embolization for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272
Spies JB, Spector A, Roth AR, Baker CM, Mauro L, Murphy-Skrynarz K (2002) Complications after uterine artery embolization for leiomyomas. Obstet Gynecol 100:873–880
Fanfani F, Fagotti A, Biulco G, Ercoli A, Malzoni M, Scambia G (2005) A prospective study of laparoscopy versus minilaparotomy in the treatment of uterine myomas. J Minim Invasive Gynecol 12:470–474
Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N (2006) Randomized study of laparoscopy versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 13:92–97
Palomba S, Zupi E, Russo T et al (2007) A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short term outcomes. Fertil Steril 88:942–951
Prapas Y, Kalogiannidis I, Prapas N (2009) Laparoscopy vs. laparoscopically assisted myomectomy in the management of uterine myomas: a prospective study. Am J Obstet Gynecol 200:144–146
Bonney V (1931) The techniques and results of myomectomy. Lancet 220:171–177
La Morte AI, Lalwani S, Diamond MP (1993) Morbidity associated with abdominal myomectomy. Obstet Gynecol 82:897–900
Ginsburg ES, Benson CB, Garfield JM, Gleason RE, Friedman AJ (1993) The effect of operative technique and uterine size on blood loss during myomectomy: a prospective randomized study. Fertil Steril 60:956–962
Fanfani F, Fagotti A, Longo R, Marana E, Mancuso S, Scambia G (2005) Minilaparotomy in the management of benign gynaecologic disease. Eur J Obstet Gynecol Reprod Biol 119:232–236
Fanfani F, Fagotti A, Ercoli A et al (2004) A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod 19:2367–2371
Fagotti A, Ferrandina G, Longo R, Mancuso S, Scambia G (2002) Minilaparotomy in early stage endometrial cancer: an alternative to standard and laparoscopic treatment. Gynecol Oncol 86:177–183
Kalogiannidis I, Lambrechts S, Amant F, Neven P, Van Gorp T, Ig Vergote (2007) Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage I endometrial cancer: safety, recurrence, and long term outcome. Am J Obstet Gynecol 196:248.e1–248.e8
Glasser MH (2005) Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol 12:275–283
Nezhat C, Nezhat F, Bess O, Nezhat CH, Mashiach R (1994) Laparoscopically assisted Myomectomy: a report of a new technique in 57 cases. Int J Fertil 39:39–44
Cagnacci A, Pirillo D, Malmusi S, Arangino S, Alessandrini C, Volpe A (2003) Early outcomes of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotmy. A randomized prospective study. Hum Reprod 18:2590–2594
Serracchioli R, Rossi S, Govoni F et al (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15:2663–2668
Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C (2001) Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod 16:1726–1731
Nezhat C, Nezhat F, Silfen SL, Schaffer N, Evans D (1991) Laparoscopic myomectomy. Int J Fertil 36:275–280
Paul PG, Koshy AK, Thomas T (2006) Pregnancy outcomes following laparoscopic myomectomy and single-layer myometrial closure. Hum Reprod 21:3278–3281
Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GM (1996) Laparoscopic versus abdominal myomectomy: a prospective randomized trial to evaluate benefits in early outcomes. Am J Obstet Gynecol 174:654–658
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Kalogiannidis, I., Prapas, N., Xiromeritis, P. et al. Laparoscopically assisted myomectomy versus abdominal myomectomy in short-term outcomes: a prospective study. Arch Gynecol Obstet 281, 865–870 (2010). https://doi.org/10.1007/s00404-009-1187-9
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DOI: https://doi.org/10.1007/s00404-009-1187-9