Update on laparoscopic myomectomy

Abstract

Our aim was to analyze the indications and factors influencing laparoscopic myomectomy and its outcome. A retrospective analysis was done of 178 patients who underwent laparoscopic myomectomy at the Department of Obstetrics and Gynaecology, University Hospitals Schleswig Holstein, Campus Kiel, Germany, between 2000 and 2003. A detailed history was taken of all patients with uterine fibroids measuring <3->10 cm in diameter. Thirty-seven patients were pretreated with gonadotropin-releasing hormone analogues. Of the 178 patients with myomas, 24% had pedunculated-subserous fibroids, 76% had intramural myomas, and none had diffuse myomatosis. The mean operating time for laparoscopic myomectomy was 90 min, and mean hospital stay was 2±0.5 days. The only complications encountered were in two patients with a small hematoma in the abdominal wall. No late complications were found. Seven of 178 cases required a second laparoscopic myomectomy. A pregnancy rate of over 55% was achieved in the infertility cases, with a 30% cesarean section rate. Postoperative recovery and resumption to normal life were quicker compared with laparotomy with low morbidity. Overall, laparoscopic myomectomies were performed for the following indications: pelvic mass (29%), metrorrhagia (17%), pelvic pain (14%), and infertility (40%). Laparoscopic myomectomy is the technique of choice for pedunculated-subserosal and intramural fibroids in properly selected cases. It requires a skilled endoscopic surgical unit and an efficient team and results in a very low morbidity. Submucous fibroids and diffuse myomatosis were not evaluated in this study. © Springer-Verlag Berlin / Heidelberg 2005.