Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience (original) (raw)
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Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010
The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. Methods: The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. Results: The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained postoperative death. Conclusions: Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas.
Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients
Journal of minimally invasive gynecology
To review surgical outcomes and histopathological findings after laparoscopic myomectomy by a team at a university teaching hospital. 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). A university teaching hospital. Women undergoing laparoscopic myomectomy. Laparoscopic myomectomy. 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 myoma...
Laparoscopic Myomectomy: Clinical Outcomes and Comparative Evidence
Journal of Minimally Invasive Gynecology, 2015
Laparoscopic myomectomy is a common surgical treatment for symptomatic uterine leiomyomas. Proponents of the laparoscopic approach to myomectomy propose that the advantages include shorter length of hospital stay and recovery time. Others suggest longer operative time, greater blood loss, increased risk of recurrence, risk of uterine rupture in future pregnancies, and potential dissemination of cells with use of morcellation. This review outlines techniques for performance of laparoscopic myomectomy and critically appraises the available evidence for operative data, short-term and long-term complications, and reproductive outcomes.
Laparoscopic myomectomy: a current view
Human Reproduction Update, 2000
Since 1990 laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from the literature, the authors report on the situation today regarding the operative technique for LM and the risks and bene®ts of the technique as compared with myomectomy by laparotomy. The operative technique comprises four main phases: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. LM offers the possibility of a minimally invasive approach to treat medium-sized (<9 cm) subserous and intramural myomata by surgery when there are only two or three of them. When conducted by experienced surgeons, the risk of peri-operative complications is no higher using this technique. Use of the laparoscopic route could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of post-operative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. The risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy.
Archives of Gynecology and Obstetrics, 2010
Purpose Comparison between laparoscopically assisted myomectomy (LAM) and abdominal myomectomy (laparotomy), used in the management of women with intramural or subserous uterine Wbroids up to 90 mm of maximum diameter. Methods Seventy-Wve 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 sig-niWcantly 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 diVerent 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, oVering signiWcant advantages.
Clinical outcome after laparoscopic and open abdominal myomectomy
Gynecological Surgery, 2012
This paper details a retrospective study evaluating long-term outcomes after laparoscopic and abdominal myomectomy, including improvement of abnormal vaginal bleeding, periodic blood loss, pelvic pain, and fertility. This is a retrospective study based on a postal questionnaire and the women's medical journal. A total of 233 women were identified as having had a myomectomy during the period 2003-2006 and were sent a postal questionnaire. The response rate was 70%. After surgery, pain score was significantly reduced. The number of days with bleeding and the degree of discomfort due to bleeding was also reduced after the surgery. Among 31% of the women who stated infertility as a reason for the myomectomy, 52% became pregnant during the observational period of 4.5 years on average. Few studies report long-term outcomes after laparoscopic and abdominal myomectomy. Despite the limitations of this retrospective study, the results imply improvements regarding periodic pain, number of days with bleeding and discomfort due to bleeding after myomectomy.
Review of Laparoscopic Myomectomy Versus Open Myomectomy
IOSR Journals , 2019
Introduction: Uterine fibroid are the commonest benign tumor found in women of reproductive age group. Mostly asymptomatic but some times it causes symptoms like abnormal menstrual bleeding, pelvic pain, pressure symptoms, subfertility. Treatment available for fibroid are medical therapy, UAE, MRI guided focused ultrasonography thermal therapy, myomectomy, hysterectomy. Myomectomy is the preferred option for women who wish to retain their reproductive function, although hysterectomy is the most definitive treatment for symptomatic fibroid, when there is no valid reason for myomectomy. Study Design: Retrospective analytical review, where searches where conducted in Pubmed, Medline, Springer, Cochrane Library to identify relevant literature. Aim and objective: The purpose of this study is to determine the better surgical method for myomectomy by comparing laparoscopic and open myomectomy with regards to surgical outcomes such as intraoperative blood loss, duration of surgery, hospital stay and intra and peri-operative complications. Conclusion: Compared to open myomectomy, laparoscopic myomectomy has added advantages such as early recovery, less post-operative pain, less duration of hospital stay, reduced intra-operative blood los, less adhesion formation. Recurrence and pregnancy rates after myomectomy are similar after both the surgeries. Despite laparoscopic myomectomy having many advantages open myomectomy is still a frequently performed procedure. Due to advantages of laparoscopic surgery, efforts have to be made to implement this procedure into daily practices by training more surgeons in this field so as to provide best care to the patients.