Size, type, and location of myoma as predictors for successful laparoscopic myomectomy: A Tertiary Government Hospital experience

Abstract

Background:Laparoscopic myomectomy (LM) is a preferred alternative to abdominal myomectomy due to shorter hospitalization, faster recovery, and decreased intraoperative adhesions. The criteria, however, which constitute proper selection of patients for LM, are still a matter of debate. Since conversion to either laparoscopic-assisted myomectomy (LAM) or laparotomy (EL) entails longer time and increased costs compared to performing an open procedure from the outset, this research aims to evaluate size, location, and type of myoma as predictors for LM.Methodology:Inpatient medical records of all women who underwent LM from January 2014 to August 2016 were retrieved and reviewed. Demographic data, intraoperative records, and postoperative course were obtained. The association of size, type, and location of myomas to the procedure performed was analyzed.Results:There was no significant association between the size of the myoma or its location to the procedure performed. However, intramural and subserous myomas were associated with successful LM, while submucous myomas were associated with conversion to either LAM or EL (P = 0.010).Conclusion:LM is a difficult procedure that challenges even the most skilled laparoscopic surgeon. Proper patient selection lessens complications and decreases the risk of conversion. In this study, type of myoma may be a good predictor for successful LM; however, this conclusion may be limited by the small sample size. A large-scale multicentric prospective study is necessary to validate the role of the proposed predictors to prevent unplanned conversion to an open procedure and reduce cost and increase safety of LM.

Comparison of surgical and obstetric outcomes in women with uterine leiomyomas after laparoscopic vs. abdominal myomectomy: A single-center cohort study

“…Although there are no universally accepted selection criteria for the surgical approach, based on our results, women with 3 or more fibroids and whose largest myoma is ≤9 cm can be successfully treated through laparoscopy. Our results agree with those of previous studies that showed that the number of complications, surgical difficulties and risk of laparoconversion increase if LM is performed in patients with these characteristics ( 11 , 20 – 22 ).…”

“…The association between the surgeon's experience and the laparoscopic approach was statistically significant ( p < 0.001), with 92% of the laparoscopies performed by expert surgeons and 66% performed by training surgeons. The surgeon's experience continues to be decisive for successful LM ( 20 , 21 ). We therefore found no association between the type of myoma and the surgical approach ( p = 0.767), given the expert surgeon's skill in managing different types of myomas.…”

Metastatic Smooth Muscle Tumor of Uncertain Malignant Potential after Laparoscopic Presuming Myomectomy

“…Among different types of uterine myoma, intramural and subserous myomas were associated with a higher successful rate. [ 2 ] Ulipristal acetate has been introduced as preoperative treatment of patients with large fibroids; however, studies showed that it results in a more technically difficult situation with the potential risk of incomplete resection due to anatomical distortion and unclear cleavage planes. [ 3 ] Although minimally invasive surgery represents the gold standard treatment, laparoscopic myomectomy still requires adequate knowledge of the risk factors for complications, of which the most common is bleeding.…”

Analysis of hidden blood loss and its influential factors in myomectomy

“…Subserosal leiomyomas are located outside the uterus, and the shallow defect in the uterus caused by enucleation of the subserosal leiomyoma can be adequately sutured and repaired. 41 In patients with intramural leiomyomas, however, especially large leiomyomas that have penetrated through the entire myometrium, suturing the deep and total layers of the myometrium may be difficult, resulting in inadequate uterine repair. 42 This may increase the amount of blood that oozes from the surgical incision, and a hematoma may form, leading to a higher perioperative HBL than in subserosal leiomyoma enucleation.…”