Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study

Cagnacci, Angelo; Pirillo, Debora; Malmusi, Stefania; Arangino, Serenella; Alessandrini, Chiara; Volpe, Alessandro

doi:10.1093/humrep/deg478

Cited by 74 publications

(123 citation statements)

References 16 publications

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“…On hospital stay ten of the 17 patients of laparoscopic surgery had been discharged while none in the laparotomy group. 13 Mais V et al in another randomized clinical study in 1996 involving 40 subjects had similar findings that pain control was better tolerated by those in the laparoscopy group than the laparotomy group. While only 3 patients needed analgesics in the laparoscopy group, 17 of the laparotomy patients needed analgesia.…”

mentioning

confidence: 70%

“…20 Postoperative pain control has been shown to be very good from the various reviews indicating clear advantages over the open conventional type of myomectomy. 13,14,18 The time taken to recovery is also short following laparoscopic myomectomy. This clearly is an advantage to the patient and the surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Early return to duty is also an added advantage although still patients may suffer from fatigue as a result of the anesthesia; they still recuperate at home. [12][13][14][15] Patient satisfaction is also another factor. The operation site does not have a big incision as is the case with conventional myomectomy.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

Mwakirungu¹,

Mishra²

2009

WJOLS

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confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

Mwakirungu¹,

Mishra²

2009

WJOLS

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“…Así también, aunque observamos un menor requerimiento de analgesia con opiáceos y una menor estadía hospitalaria en pacientes operadas por laparoscopia, las diferencias se minimizan o desaparecen cuando se comparan miomas que miden menos de 5 cm. Estos resultados contrastan con los resultados de algunas series internacionales en donde se demuestra los beneficios de la laparoscopia en términos de dolor postoperatorio, pérdidas hemáticas, estadía hospitalaria y tiempo de recupe-ración (4,7,8,(11)(12)(13)(14)(15).…”

Section: Discussionunclassified

Miomectomía Abdominal Versus Miomectomía Laparoscópica: Experiencia Preliminar Del Hospital Clínico De La Pontificia Universidad Católica De Chile

Sigüenza²,

et al. 2009

Rev. chil. obstet. ginecol.

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RESUMENAntecedentes: Múltiples pacientes requieren un manejo conservador del mioma uterino. Muchas de ellas no han completado su paridad, y otras no desean la remoción del útero preocupadas del impacto que esa alternativa tenga en su vida sexual. Objetivos: Evaluar nuestra experiencia en pacientes miomectomizadas mediante laparoscopia o laparotomía y revisar la literatura para definir las ventajas de cada técnica y recomendaciones para su indicación. Método: Estudio prospectivo, no randomizado, de pacientes miomectomizadas en el Servicio de Ginecología del Hospital Clínico de la Universidad Católica de Chile, durante el período noviembre de 2007 y mayo de 2008. Resultados: La población incluida fue de 43 casos; 16 casos correspondieron a miomectomía laparoscópica (37,2%) y 27 a miomectomía por laparotomía (67,8%). La miomectomía por laparotomía se realizó en 40% de los casos utilizando una incisión transversa mínima. Esta vía de abordaje fue más frecuentemente utilizada cuando se trataba de miomas de gran tamaño o de múltiples miomas. En nuestra serie, la miomectomía laparoscópica se asociaría a un menor requerimiento de analgesia. No hay diferencias en la frecuencia de complicaciones, tiempo operatorio y estadía hospitalaria entre ambas técnicas, cuando se trata de miomas operados menores de 5 cm. Conclusión: Nuestros resultados sugieren que la miomectomía por laparotomía es una técnica segura que debiese privilegiarse cuando se trata de miomas grandes y múltiples. La laparoscopia es igualmente segura reservada para casos bien seleccionados y cirujanos experimentados en el procedimiento.PALABRAS CLAVE: Mioma, miomectomía, cirugía, laparoscopia, complicaciones SUMMARY Background: Multiple patients ask for a conservative management of uterine fibroids. Some of the patients have not completed their parity at the time of surgery, and others do not want an hysterectomy worried about de impact of this procedure in their sexual life. Objectives: The objective of this study was to evaluate our experience in the short term surgical results of patients undergoing a laparoscopic or abdominal myomectomy. We also did a literature review to define the advantages for each technique and their indications. Methods: A prospective, non-randomized study comparing short term surgical outcomes in patients undergoing laparoscopic versus abdominal myomectomy in the Gynecology Service of the Clinical Hospital of the Pontificia Universidad Católica de Chile, between November 2007 and May 2008. Results: Forty-three patients undergoing myomectomy in our centre were analyzed. 16 of them were approached by laparoscopy (37.2%)

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“…LM is a technically demanding procedure requiring special skills, such as the ability to perform laparoscopic suturing [10,11]. LAVM or LAM may offer better management by decreasing these technical demands, as they allow exact suturing of the uterine defect in layers.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic-assisted vaginal myomectomy: a feasibility study

et al. 2005

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This pilot study assessed the feasibility and complications of a combined laparoscopic and vaginal approach through the posterior colpotomy in cases of fundal or posterior wall uterine fibroids. Twenty-four women with single symptomatic fibroids (size 5-8 cm) were prospectively assigned to undergo either laparoscopic-assisted vaginal myomectomy (LAVM; n=12) or laparoscopic myomectomy (LM; n=12). Surgical characteristics, hospital stay, and complications were analyzed. Blood samples for assay of tissue markers [C-reactive protein (CRP), creatine kinase (CK), and white blood cell count] and hemoglobin were taken preoperatively and on the 1st and 3rd postoperative days. There were no differences between the two groups with regard to demographic characteristics. The mean operating time was shorter in the LAVM group (64.44±17.4 min vs. 89.00±23.4 min, P<0.05). There was no difference in blood loss or complications between the groups. One woman in the LM group required vaginal conversion for an unsuccessful hemostasis during laparoscopic coagulation. The difference in decline of hemoglobin and tissue marker levels was statistically insignificant. Only the serum CRP level was statistically different between the groups. This may indicate that the local abdominal wall injury in the LM group was influenced by minilaparotomy in two cases of larger fibroids. In both groups, serum CRP was significantly increased when blood loss was greater than 200 ml. In conclusion, LAVM is a feasible minimally invasive procedure and has also been associated with a shorter operating time compared with LM. A combined laparoscopic and vaginal approach in dealing with fundal and/or posterior wall uterine fibroids through the posterior cul-de-sac is an alternative to either pure laparoscopic myomectomy or laparoscopic-assisted myomectomy.

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Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study

Abstract: In selected cases, myomectomy by LA-MLT offers some advantages versus LT and, to a smaller extent, MLT.

Cited by 74 publications

References 16 publications

Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

Miomectomía Abdominal Versus Miomectomía Laparoscópica: Experiencia Preliminar Del Hospital Clínico De La Pontificia Universidad Católica De Chile

Laparoscopic-assisted vaginal myomectomy: a feasibility study

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