Minimally invasive approaches to myomectomy

Objectives:

To evaluate the feasibility of uterus-preserving surgery in patients with symptomatic uterine fibroids based on patient and fibroid characteristics in reproductive age.

Methods:

A retrospective study, the records of 295 patients who underwent single or multiple myomectomies for symptomatic fibroids from 2010 to 2015 were reviewed. Statistical analysis was performed using descriptive statistics and the Mann-Whitney U test.

Results:

The total number of patients who underwent myomectomy was 295, of them laparoscopic myomectomy (LM) was 184 (62.4%), hysteroscopic myomectomy (HSCM) was 98 (33.2%), and abdominal myomectomy (AM) was 13 (4.4%). The mean age of patients in the LM group was 36.77 ± 6.54 years, in the AM group was 35.0 ± 4.7 years and in the HSCM group was 43.10 ± 10.26 years. The mean cumulative diameter of uterine fibroids in the AM group was 14.1 ± 4.41 cm, which was significantly higher than the 8.94 ± 3.1 cm in the LM group (p < 0.001). The mean cumulative diameter of fibroids in the in the HSCM was 3.68 ± 1.64 cm. Furthermore, LM and HCSM were performed when the mean diameter of the largest fibroid was up to 18.50 cm and 5.5 cm, respectively. The mean weight of fibroids was considerably greater in the AM group, at 333.05 ± 481.38 g, in comparison to the LM group, which showed a mean weight of 90.16 ± 104.78 g. (p < 0.001). The mean weight of the fibroids in HSCM group was 12.81 ± 6.43 g.

Conclusion:

LM and HCSM are reliable procedures even in the presence of enlarged fibroid, up to 10 cm and 5.5 cm, respectively.