Comparison of laparoscopic myomectomy using in situ morcellation with and without uterine artery ligation for treatment of symptomatic myomas.

Abstract

STUDY OBJECTIVE:

To evaluate the efficacy of laparoscopic uterine artery ligation (LUAL) before in situ morcellation (ISM) compared with ISM alone.

DESIGN:

Prospective study (Canadian Task Force classification II-1).

SETTING:

University-affiliated hospital.

PATIENTS:

One hundred forty-four women with symptomatic uterine myomas, of whom 45 underwent LUAL and ISM and 99 underwent ISM only, from August 2007 through August 2009.

INTERVENTIONS:

Ligation or no ligation of the uterine arteries before ISM.

MEASUREMENTS AND MAIN RESULTS:

In the LUAL+ISM group compared with the ISM group, mean (SD) operative time was significantly longer (107 [34] minutes vs 93 [35] minutes; p = .03), and there was less intraoperative blood loss (84 [53] mL vs 137 [166] mL; p < .001). Eight patients in the ISM group (8.1%) required a blood transfusion, including 4 (4.0%) with excessive intraoperative bleeding and 4 (4.0%) with postoperative hematomas. Although myomas in the LUAL+ISM group weighed more (p < .001), none of the patients in that group had excessive intraoperative bleeding, postoperative hematomas, or required blood transfusion (p = .046). At 2 years of follow-up, in the LUAL+ISM group compared with the ISM group, the myoma recurrence rate was 7% vs 24%, and symptom improvement was reported by 98% of patients vs 86% (statistically significant).

CONCLUSION:

Laparoscopic myomectomy using an ISM technique with or without simultaneous LUAL may be used in the management of symptomatic uterine myomas; however, LUAL+ISM may result in a better surgical outcome.

• Authors: Wen-Chun Chang, Pei-Shen Huang, Peng-Hui Wang, Daw-Yuan Chang, Su-Cheng Huang, Szu-Yu Chen, Li-Yun Chou, Bor-Ching Sheu
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2012 Nov-Dec Vol. 19 Issue 6 Pg. 715-21 ISSN: 1553-4669 [Electronic] United States
• PMID: 23084675 (Publication Type: Comparative Study, Controlled Clinical Trial, Journal Article)
• Copyright: Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Blood Loss, Surgical (prevention & control)
• Blood Transfusion
• Blood Volume
• Female
• Follow-Up Studies
• Hematoma (etiology)
• Humans
• Laparoscopy (adverse effects, methods)
• Leiomyoma (surgery)
• Ligation
• Middle Aged
• Operative Time
• Recurrence
• Uterine Artery (surgery)
• Uterine Neoplasms (surgery)
• Young Adult