J Korean Med Sci.  2007 Aug;22(4):706-712. 10.3346/jkms.2007.22.4.706.

Laparoscopic Myomectomy for Large Myomas

• Yoon HJ
• Kyung MS
• Jung US
• Choi JS

• KMID: 1127091
• DOI: http://doi.org/10.3346/jkms.2007.22.4.706

Abstract

The aim of this study was to assess the feasibility and efficacy of laparoscopic myomectomy (LM) for large myomas. A subpopulation of 51 patients with myomas 8 cm or larger in diameter was selected from 155 patients who underwent LM at Kangbuk Samsung Hospital from July 2003 to November 2006. The mean age of the patients was 34.9+/-5.6 yr, mean parity was 0.6+/-0.9, and 8 patients had a previous operative history. The most common operative indication was a palpable abdominal mass (24 patients, 47%). The mean operating time was 85.6+/-38.9 min, and the mean diameter of the largest myoma was 9.3+/-1.8 cm. The mean change in hemoglobin concentration was 2.1+/-1.2 g/dL. Histopathological diagnosis included 49 patients of leiomyoma (96.1%) and 2 patients of leiomyoma with adenomyosis (3.9%). Postoperatively, a transfusion was done in 7 patients, and a case of subcutaneous emphysema was noted. None of the operations was switched to laparotomy. With the newly-developed screw and the port placement system that was modified from the Choi's 4-trocar method to obtain better surgical vision, LM of large myomas proved to be one of the efficient and feasible methods.

Keyword

Laparoscopic Myomectomy; Myoma Uteri; Laparoscopy

MeSH Terms

Adult
Feasibility Studies
Female
Humans
Laparoscopy/adverse effects/*methods
Leiomyoma/pathology/*surgery
Length of Stay
Postoperative Complications/etiology
Reproducibility of Results
Subcutaneous Emphysema/etiology
Treatment Outcome
Uterine Neoplasms/pathology/*surgery

Figure

• 

  Fig. 1 (A) Port placement system of laparoscopic myomectomy for large myomas. (B) New metallic screw.

• 

  Fig. 2 (A) Intramural myoma of 9 cm in diameter on the posterior uterine wall on ultrasonography. (B) An image of a new metallic screw fixed to the myoma after peeling off the capsule of the myoma. (C) An image of the uterus after laparoscopic myomectomy.

• 

  Fig. 3 Comparison between this study and the previous studies in myoma size (A), operating time (B), hemoglobin change (C), and ratio with complication (D).

Reference

1. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005. 83:1–23.

2. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N. Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol. 2006. 13:92–97.

3. Sinha R, Hegde A, Warty N, Patil N. Laparoscopic excision of very large myomas. J Am Assoc Gynecol Laparosc. 2003. 10:461–468.

4. Marret H, Chevillot M, Giraudeau B. Factors influencing laparoconversions during the learning curve of laparoscopic myomectomy. Acta Obstet Gynecol Scand. 2006. 85:324–329.

5. Marret H, Chevillot M, Giraudeau B. A retrospective multicentre study comparing myomectomy by laparoscopy and laparotomy in current surgical practice. What are the best patient selection criteria? Eur J Obstet Gynecol Reprod Biol. 2004. 117:82–86.

6. Damiani A, Melgrati L, Marziali M, Sesti F, Piccione E. Laparoscopic myomectomy for very large myomas using an isobaric (gasless) technique. JSLS. 2005. 9:434–438.

7. Glasser MH. Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol. 2005. 12:275–283.

8. Fanfani F, Fagotti A, Bifulco G, Ercoli A, Malzoni M, Scambia G. A prospective study of laparoscopy versus minilaparotomy in the treatment of uterine myomas. J Minim Invasive Gynecol. 2005. 12:470–474.

9. Choi JS, Kyung YS, Kim KH, Lee KW, Han JS. The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri. J Minim Invasive Gynecol. 2006. 13:276–280.

10. Wang CJ, Yuen LT, Lee CL, Kay N, Soong YK. Laparoscopic myomectomy for large uterine fibroids: a comparative study. Surg Endosc. 2006. 20:1427–1430.

11. Lee YS. Benefits of high epigastric port placement for removing the very large uterus. J Am Assoc Gynecol Laparosc. 2001. 8:425–428.

12. Takeuchi H, Kuwatsuru R. The indications, surgical techniques, and limitations of laparoscopic myomectomy. JSLS. 2003. 7:89–95.

13. Sinha R, Hegde A, Warty N, Mahajan C. Laparoscopic myomectomy: enucleation of the myoma by morcellation while it is attached to the uterus. J Minim Invasive Gynecol. 2005. 12:284–289.

14. Ostrzenski A. A new laparoscopic myomectomy technique for intramural fibroids penetrating the uterine cavity. Eur J Obstet Gynecol Reprod Biol. 1997. 74:189–193.

15. Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, Flamigni C. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000. 15:2663–2668.

16. Kim HC, Oh ST. Safety and usefulness of laparoscopic myomectomy for intramural myoma in reproductive women. Korean J Obstet Gynecol. 2000. 43:659–664.

17. Semm K, Mettler L. Technical progress in pelvic surgery via operative laparoscopy. Am J Obstet Gynecol. 1980. 138:121–127.

18. Landi S, Zaccoletti R, Ferrari L, Minelli L. Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc. 2001. 8:231–240.

19. Lee SY, Ryu HH, Lee CB, Joo EH, Kim SK. Clinical review on 93 cases of laparoscopic myomectomy. Korean J Obstet Gynecol. 2004. 47:1107–1112.

20. Mettler L, Schollmeyer T, Shelat NR, Jonat W. Update on laparoscopic myomectomy. J Gynecol Surg. 2005. 2:173–177.

21. Malzoni M, Sizzi O, Rossetti A, Imperato F. Laparoscopic myomectomy: a report of 982 procedures. Surg Technol Int. 2006. 15:123–129.