Symptomatic myoma treated with laparoscopic uterine vesel occlusion and subsequent immediate myomectomy: which is the optimal surgical approach?

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摘要

Abstract

Objective: To determine the optimal surgical approach when patients are treated with laparoscopic uterine vessel

occlusion (LUVO) combined with myomectomy in the management of women with symptomatic uterine fibroids.

Design: An observational study. Setting: Medical centers.

Patient(s): One hundred thirty-one patients with symptomatic myomas underwent LUVO plus laparoscopic

myomectomy (LM; LUVOþLM) (n ¼ 49) or LUVO plus ultra-mini laparotomy UMLT-M (LUVOþUMLT-M)

(n ¼ 82).

Intervention(s): Myomectomy through laparoscopy or UMLT access.

Main Outcome Measure(s): The outcome was measured by comparing surgical techniques, and 3-year follow-up,

including symptom control and reintervention (hysterectomy or myomectomy), in both groups.

Result(s): General characteristics of the patients were similar in both groups, except the number of myomas.

Surgical techniques seemed to be easier in the LUVOþUMLT-M group than in LUVOþLM group, because of

less operation time (56.1 16.9 minutes vs. 73.4 26.9 minutes; P¼.009) and a higher success rate (100% vs.

91.8%; P¼.018). There were no differences in the 3-year follow-up of the therapeutic outcomes of the

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LUVOþUMLT-M and LUVOþLM groups, with low reintervention rates (1.2% vs. 0) and good symptom control

rates in both groups.

Conclusion(s): The LUVOþLM, either through laparoscopy or UMLT, was acceptable in the management of

symptomatic uterine fibroids. However, the LUVOþUMLT-M technique might be more feasible, as it required

less operative time and had a higher success rate. (Fertil Steril 2009;92:762–9. 2009 by American Society