Laparoscopic myomectomy called safe, reliable.(Gynecology)

NEW YORK -- Laparoscopic myomectomy is safe and reliable, even in the presence of multiple or enlarged myomas, Ornella Sizzi, M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.

Although laparoscopic myomectomy was first performed more than 20 years ago, there is still debate about its indications, as well as postoperative reproduction outcomes and recurrence rates. However, compared with laparotomic myomectomy, the laparoscopic procedure has clearly been shown to result in a reduced hemoglobin drop, less postoperative pain, less febrile morbidity, and faster recovery time.

"Considering the high recurrence rate also with laparotomy and the consequent risk of repeated surgery, we think that patients should be offered the least invasive surgical approach available," said Dr. Sizzi of Villa Valeria Hospital, Rome.

She reported her institution's experience with 332 patients who underwent laparoscopic myomectomy between 1991 and 2003 and were not lost to follow-up. All had symptomatic myomas measuring at least 4 cm in diameter. The patients had an average of 2.23 myomas each (range 1-8), with an average size of 6 cm (range 1-20 cm).

The duration of the entire procedure ranged from 30 to 360 minutes, the average drop in hemoglobin was 1.06 g/100 mL. and the conversion rate to laparotomy was 1.5%.

Over a follow-up of 148 months, the recurrence rate was 25%, which is similar to rates reported in the literature for laparotomic myomectomy, she noted.

Pregnancies occurred in 56.5% of these patients, similar to the rates of 53.6% for laparoscopic myomectomy and 55.9% for laparotomic myomectomy seen in a previous prospective, randomized study (Hum. Reprod. 2000;15:2663-8). Spontaneous abortion rates did not differ from those reported with the laparotomic procedure.