The efficacy and feasibility of the laparoscopy assisted mini-lap myomectomy (LAMM) of huge myoma

Kim, Hyun Jung; Moon, Hwa Sook; Park, Keun Sik; Kim, Tae Wan; Joe, Young Rock; Kim, Su Hong; Kim, Tae Yong; Kim, Sang Gap

Abstract

OBJECTIVE
To evaluate the effectiveness and feasibility of the laparoscopy assisted mini-lap myomectomy (LAMM) as an alternative to laparotomy for patients with multiple or huge myoma unsuitable for laparoscopic myomectomy.
METHODS
Uncontrolled retrospective study was done on the forty-six women with myoma of 16 or more gestational sized who were undertaken laparoscopy assisted mini-lap myomectomy. The operative procedures consisted of: 1) examination of pelvic cavity, 2) infiltration of diluted vasopressin, 3) enucleation of myoma, 4) suture of uterus, and 5) removal of myoma. The examination of pelvic cavity was always done using laparoscopy. Either the laparoscopic or mini-lap method for each of the remaining steps was determined depending on the characteristics of the cases. Before operation, patients with severe anemia were corrected by the administration of oral or parenteral iron.
RESULTS
The mean age of the patients was 33.3 +/- 4.7 years, their mean gravidities and parities were 0.74 and 0.24, respectively. Of 46 patients, 28 women were married and 20 desired childbearing. The mean (+/-SD) myoma weight was 501 +/- 353 (range 130-1600) gm. The mean operation time was 87.0 +/- 31.3 minutes and blood loss was 208 +/- 239 mL. The mean incision length of mini- lap was 4.6 +/- 1.1 (range 2.5-6) cm. Postoperatively, 1 case of wound abscess occurred. Postoperative mild anemia was correctable with oral iron. Most patients were resumed normal activity within 3 weeks. The mean period of follow-up was 20 (range 6-58) months. Of 20 who desired childbearing, 15 women were follow-up and 9 women conceived. In 6 patients who underwent cesarean section, no significant adhesion or defect was found in the uterus.
CONCLUSION
These results suggest that LAMM is feasible and safe minimal invasive method that could replace routine laparotomy in patients with huge myoma.