A Clinical Study on Laparoscopic Myomectomy

Park, E J; Kong, H S; Na, J H; Kim, J H; Kim, Y M; Kim, Y T; Kang, B M; Nam, C H; Mok, J E

Abstract

Traditionally, the myomectomy has been performed via laparotomy and there have been some reports that laparoscopic myomectomy has advantages of reduced intra-and postoperative morbidity, shorter hospital stay and recovery time, earlier return to normal activities, fewer postoperative adhesions and better cosmetic scars as compared with traditional abdominal myomectomy. However, the disadvantages of the laparoscopic myomectomy include increased operating time, inability to palpate the uterus during operation, and the requirement of advanced technical skills. Actually the role of laparoscopic myomectomy remains controversial until now. We experienced 33 cases of laparoscopic myomectomy from January 1996 to December 1997, but most of them were performed ancillarily during other operations for ovarian tumors, pelvic endometriosis, tubal pregnancies, etc. Among 33 patients, ten received laparoscopic myomectomy as a major procedure. We present clinical characteristics of these patients and laparoscopic procedures we performed. The average age of patients was 36.0+/-7.0 (mean+/-S.D.) years and the mean parity was 1.3 (+/-1.2). The myomas were subserosal type in 5 cases, intramural type in 4 cases and intraligamentary type in one. The maximal diameter of the myomas ranged from 1.5 to 7.5 cm and the mean diameter was 5.2 (+/-1.6) cm. Seven cases had only one myoma, but 3 cases had two or more. The operation time ranged from 65 to 200 minutes (mean: 121.5+/-46.4) and average hemoglobin change(preoperative- postoperative hemoglobin) was 2.5 (+/-1.2) g/dl. There was no intraoperative and postoperative complication except one case of trocar site hemorrhage. In conclusion, the laparoscopic procedure is effective for myomectomy, but it is essential to adhere to the basic surgical principles to optimize its safety and efficacy. However, its advantages are still needed to be established based on long term outcomes.