Laparoscopic Myomectomy for Large Fibroids with Synchronized use of Uterine Artery Embolization

Abstract

Objective: To determine the feasibility and efficacy of the laparoscopic myomectomy for large fibroids (>10 cm) with use of synchronous uterine artery embolization.Design: A prospective observational case series of laparoscopic myomectomy performed for single and multiple uterine fibroids.Setting: A tertiary referral center for gynecological oncology and minimal access surgery. Materials and methods:Laparoscopic myomectomy was performed using harmonic scalpel with synchronized preoperative uterine artery embolization (UAE) following multidisciplinary team discussion. Tissue retrieval was performed by morcellation. Main outcome measures:Early discharge and reduced intraoperative blood loss.Results: Of all 15 cases, mean number of fibroids removed was 2 (range: 1-4) and mean mass of tissue excised was 450 gm (range: 320-1540). The mean diameter of the fibroids removed was 13 cm (range: 10-20 cm). Mean estimated blood loss was 156 ml (range: 25-1,000 ml) and the mean operating time was 113 minutes (17-200 minutes). All cases were successfully completed laparoscopically with no conversions to open surgery. One patient who had a 13 cm broad ligament fibroid required a 2 unit blood transfusion intraoperatively and another patient developed a single port-site infection 2 weeks following the procedure. Histology confirmed benign leiomyomas in all cases. Conclusion:Laparoscopic myomectomy with use of synchronized UAE using harmonic scalpel is feasible and efficient procedure for single or multiple large fibroids within an experienced multidisciplinary setting.