Laparoscopic Myomectomy: A Report of 982 Procedures
Mario Malzoni, M.D., Malzoni Medical Center, Avellino, Italy; Ornella Sizzi, M.D., "Villa Valeria" Hospital, Rome, Italy; Alfonso Rossetti, M.D., "Villa Valeria" Hospital, Rome, Italy; Fabio Imperato, M.D., Malzoni Medical Center, Avellino, Italy
We have reported the experience of two referral laparoscopic gynecologic centers in Italy considering the results of almost 1000 laparoscopic myomectomies, including complication rate and fertility outcome. From January 1991 to December 2003, a total of 982 single or multiple laparoscopic myomectomies (LM) were performed. Indications were infertility, recent and significant uterine enlargement, and other symptoms such as pelvic pain, menometrorrhagia, and abnormal bleeding. All surgical procedures were performed by three surgeons in two different endoscopic centers. Surgery outcome and information about subsequent fertility and obstetric outcome were reported. Myomectomies were performed using a standard technique with three ancillary suprapubic ports. In cases of deep intramural myomas, we injected the myomas with vasoconstrictive agents. A vertical incision of the serosa was made and mechanical enucleation of the myomas was performed whenever possible. A suture in one or two layers with large, curved needles (CT 1, 30 mm) swaged to polyglactin 1 or 0 sutures was performed. Extraction of the removed myomas took place with electric morcellation. Most patients (47%) had more than one myoma, with a maximum of eight per patient (average myomas removed for patients: 2.23). Myoma size ranged from 1 cm to 20 cm (average 67.20 mm ± 27.1 mm ). Most of the myomas (75%) were intramural. The average drop in hemoglobin concentration was 1.06 g ± 0.86 g/100 ml. The duration of the entire procedure ranged from 30 min to 360 min with a mean of 104.5 min. The conversion rate to laparotomy was 1.29% and no major intraoperative complications occurred. The mean postoperative hospital stay was 2.02 days ± 0.61 days and we had three serious postoperative complications. The overall rate of intrauterine pregnancy following LM was 62.53% and the abortion rate was 15.9%. Data suggest that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or very enlarged myomas, with a low complication rate and satisfying long-term results.