A Systematic Review on Efficacy and Safety of Gasless Laparoscopy in the Management of Uterine Leiomyoma

• Published in: Journal of Huazhong University of Science and Technology. Medical sciences Vol. 36; no. 1; pp. 142 - 149
• Main Author: 刘麒薇 韩桐 杨敏 童晓文 王建军
• Format: Journal Article
• Language: English
• Published: Wuhan Huazhong University of Science and Technology 01.02.2016; Department of Gynecology and Obstetrics,Affiliated Tongji Hospital,Tongji University,Shanghai 200065,China%Women's Hospital,School of Medicine,Zhejiang University,Hangzhou 310006,China
• Subjects: Adult; Female; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Leiomyoma - surgery; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Postoperative Complications; Uterine Neoplasms - surgery; 临床; 医学; 症状; 诊断; meta-analysis; minimally invasive procedures; gasless laparoscopy; systematic review; uterine leiomyoma
• ISSN: 1672-0733; 1993-1352
• DOI: 10.1007/s11596-016-1557-z

Uterine leiomyoma causes considerable morbidity in women. This study systematically reviewed the efficacy and safety of gasless laparoscopic myomectomy（GLM） in the management of uterine leiomyoma by comparing GLM with other minimally invasive procedures. Cochrane Library, PubMed, EMBASE, Web of Science, WANFANG database and China National Knowledge Infrastructure（CNKI） were searched for studies published in English or Chinese between January 1995 and May 2015, and related references were traced. Study outcomes from randomized controlled trials and retrospective cohort studies were presented as mean difference（MD） or odds ratio（OR） with a 95% confidence interval（CI）. Seventeen studies（including 1862 patients） meeting the inclusion criteria, including 934 treated with GLM and 928 treated with other minimally invasive procedures were reviewed. The results of meta-analysis revealed that GLM resulted in significantly shorter operating time [MD=–10.34, 95% CI（–18.12, –2.56）, P〈0.00001], shorter hospital stay [MD=–0.47, 95% CI（–0.88, –0.06）], less time to flatus [MD=–2.04, 95% CI（–2.59, –1.48）], less postoperative complications [OR=0.20, 95% CI（0.06, 0.62）] and less blood loss [MD =–30.74, 95% CI（–47.50, –13.98）]. On the other hand, there were no significant differences in duration of post-operative fever [MD=–0.52, 95% CI（–1.46, 0.42）] between the two groups. Additionally, GLM was associated with lower febrile morbidity, lower postoperative abdominal pain, and higher postoperative hemoglobin than other minimally invasive procedures for the treatment of uterine leiomyoma. In conclusion, GLM and other minimally invasive procedures are feasible, safe, and reliable for uterine leiomyoma treatment. However, available studies show that GLM is more effective and safer than other minimally invasive approaches.