Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports

• Published in: Human reproduction (Oxford) Vol. 27; no. 2; pp. 427 - 435
• Main Authors: Tinelli, Andrea, Hurst, Brad S., Hudelist, Gernot, Tsin, Daniel Alberto, Stark, Michael, Mettler, Liselotte, Guido, Marcello, Malvasi, Antonio
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.02.2012
• Subjects: Adult; Biological and medical sciences; Delivery, Obstetric; Europe - epidemiology; Female; Follow-Up Studies; Gynecologic Surgical Procedures - adverse effects; Gynecologic Surgical Procedures - methods; Gynecology. Andrology. Obstetrics; Humans; Infertility, Female - etiology; Infertility, Female - prevention & control; Laparoscopy - adverse effects; Laparoscopy - methods; Leiomyoma - pathology; Leiomyoma - physiopathology; Leiomyoma - prevention & control; Leiomyoma - surgery; Leiomyomatosis - pathology; Leiomyomatosis - physiopathology; Leiomyomatosis - prevention & control; Leiomyomatosis - surgery; Medical sciences; Myometrium - pathology; Myometrium - surgery; Postoperative Complications - prevention & control; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Prospective Studies; Reoperation; Secondary Prevention; United States - epidemiology; Uterine Neoplasms - pathology; Uterine Neoplasms - physiopathology; Uterine Neoplasms - prevention & control; Uterine Neoplasms - surgery; Uterine Rupture - prevention & control; United States; Europe; laparoscopic myomectomy; surgical outcomes; uterine fibroids; leiomyoma; pseudocapsule; Myoma; Prognosis; myomectomy; Laparoscopy; Female genital diseases; Vertebrata; Mammalia; Surgery; Uterine diseases; Uterine leiomyoma; Benign neoplasm
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/der369

BACKGROUND Our aim was to assess surgical complaints and reproductive outcomes of laparoscopic intracapsular myomectomies by a prospective observational study run in University affiliated hospitals. METHODS Between 2005 and 2010, 235 women underwent subserous and intramural laparoscopic myomectomy of fibroids (4–10 cm in diameter) for indications of pelvic pain, menstrual disorders, a large growing myoma or infertility. The main outcome measures were post-surgical parameters, including complications, the need for subsequent surgery or symptomatic relief, resumption of normal life and reproductive outcome. RESULTS Pelvic pain occurred in 27%, menorrhagia or metorrhagia in 21%, a large growing myoma in 10% and infertility in 42% of women. Single fibroids occurred in 51.9% of patients while 48.1% had multiple myomas. Of all patients, 58.2% had subserosal and 41.8% had intramural myomas. No laparoscopies were converted to laparotomy. In 3 years, 1.2% of patients had a second laparoscopic myomectomy for recurrent fibroids. The mean total operative laparoscopic time was 84 min (range 25–126 min), with mean blood loss of 118 ± 27.9 ml. By 48 h after surgery, 86.3% were discharged with no major post-operative complications. No late complications, such as bleeding, urinary tract infections or bowel lesions, occurred. Of the women who underwent myomectomy for infertility, 74% finally conceived. At term, 32.9% of patients underwent Caesarean section, 24.8% delivered by vacuum extractor and 42.2% had spontaneous deliveries. No case of uterine rupture occurred. CONCLUSIONS Intracapsular subserous and intramural myomectomy saving the fibroid pseudocapsule showed few early and no late surgical complications, enhanced healing by preserving myometrial integrity and allowed a good fertility rate and delivery outcome. In young patients suffering fibroids, laparoscopic intracapsular myomectomy is a potential recommended surgical treatment.