Laparoscopic myomectomy: A safe, successful alternative

In one of the largest studies conducted on laparoscopic myomectomy and the first focused on complications, researchers found the complication rate of the procedure to be acceptable when compared to rates associated with laparotomic myomectomies, leading them to conclude that the procedure is safe when performed by experienced hands and successful in terms of pregnancy outcomes.

The study, performed in Italy, included data on 2,050 laparoscopic myomectomies performed between 1998 and 2004. Almost half the women in the study (48%) had more than one myoma. Total complication rate was 11.1%; minor complications accounted for 9.1%, the most common of which were febrile morbidity (5.1%) and urinary tract infections (3.4%). Major complications accounted for 2.02%. Fourteen women (0.68%) developed a hemorrhage, three (0.14%) of which required blood transfusions. Ten (0.48%) developed postoperative hematomas. One (0.04%) suffered a bowel injury, one (0.04%) developed postoperative acute kidney failure, two (0.09%) developed sarcomas, and seven (0.34%) failed to complete planned surgery. Of two (0.09%) readmitted for surgery, one had a laparoscopic hysterectomy because of severe blood loss and the other required drainage of a hematoma in the broad ligament. After about 3.5 years of follow-up, almost one quarter (22.9%) conceived, resulting in a pregnancy rate in those wishing pregnancy of 69.8%. About 20% miscarried, a rate comparable with the population at large. Eighty-one percent delivered at term via elective cesarean section; the remainder delivered vaginally. One (0.26%) reported spontaneous uterine rupture at 33 weeks' gestation.

The researchers determined that the probability of complications rises significantly with an increase in the number of myomas (e.g., more than three, OR 4.46, P<0.001) and with myoma location (e.g., intramural OR 1.48, P<0.05; intraligamentous OR 2.36, P<0.01). Myoma size is most closely associated with risk for major complications (OR 6.88, P<0.001).