La myomectomie par cœlioscopie en 2007: état des lieux

Comparison study of consecutive 100 cases of single port vs. multiport laparoscopic myomectomy; technical point of view

We report our experience with single-port and multiple-port laparoscopic myomectomy with operative outcomes and surgical skills. Hundred consecutive patients underwent single-port laparoscopic myomectomy (SP-LM) and 69 multi-port laparoscopic myomectomy (MP-LM). The operative outcomes were compared between the two methods. All procedures were successfully completed without conversion to abdominal myomectomy. The mean maximum diameter of the largest myoma was 7.4 (5-13) vs. 6.8 (5-12) cm and the mean number of myomas was 1.7 vs. 1.6 in SP-LM and MP-LM group, respectively. Mean operative time was 134.2 vs. 122.9 min in SP-LM and MP-LM group (p = .109). We showed that SPL myomectomy is a safe and feasible technique compared to MPL myomectomy with respect to postoperative pain, mean operating time, mean estimated blood loss and length of stay. To improve suturing technique of SP-LM, the working instruments were placed external to the telescope with 'micro-triangulation'.

Laparoscopic myomectomy: an intent-to-treat study

INTRODUCTION

Laparoscopic myomectomy can be performed by most advanced laparoscopic gynecologic surgeons if they have appropriate mentoring. Despite this, it is still an underused procedure. In this article, we report our ten-year experience with laparoscopic myomectomy with focus on blood loss and hemostasis.

MATERIALS AND METHODS

From July 1999 to May 2009, forty-one patients from our suburban gynecology practice underwent laparoscopic myomectomies which were performed by one surgeon (Dr Heaton). We studied the most important factors that affect the completion of the procedure without conversion to the open route.

RESULTS

Fibroids measured up to 15.6 cm on preoperative ultrasound and weighed up to 555 g from pathology report with no malignancy found. Eight patients were treated with Lupron before surgery to reduce the size of the fibroids. Pitressin was used in twenty-three patients during surgery to decrease bleeding. Nineteen cases required morcellation. Blood loss range was 20-1,200 cc and was dependent on the myoma size. One case required staged myomectomy because of bleeding (800 cc) after the large fibroid was removed. No patient required transfusion. No patient required conversion to the open technique. Patients were discharged the day of surgery in the majority of cases. No infections occurred. Two patients had successful pregnancies after myomectomy in this series and were delivered by C-section. Subsequent hysterectomy was performed in six patients at 3-72 months.

CONCLUSIONS

Laparoscopic myomectomy is a safe procedure in the hands of an experienced advanced laparoscopic surgeon. Blood loss is dependent on the myoma size and bleeding is the most serious intraoperative complication which may require performing a staged laparoscopic myomectomy, conversion to open myomectomy or blood transfusion. Maintaining homeostasis is the chief requirement to successfully and uneventfully complete the procedure without conversion to the open route.