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Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy?
J Minim Invasive Gynecol. 2008 May-Jun; 15(3):292-300.JM

Abstract

STUDY OBJECTIVE

To assess whether it is possible for an experienced laparoscopic surgeon to perform efficient laparoscopic myomectomy regardless of the size, number, and location of the myomas.

DESIGN

Prospective observational study (Canadian Task Force classification II-1).

SETTING

Tertiary endoscopy center.

PATIENTS

A total of 505 healthy nonpregnant women with symptomatic myomas underwent laparoscopic myomectomy at our center. No exclusion criteria were based on the size, number, or location of myomas.

INTERVENTIONS

Laparoscopic myomectomy and modifications of the technique: enucleation of the myoma by morcellation while it is still attached to the uterus with and without earlier devascularization.

MEASUREMENTS AND MAIN RESULTS

In all, 912 myomas were removed in these 505 patients laparoscopically. The mean number of myomas removed was 1.85 +/- 5.706 (95% CI 1.72-1.98). In all, 184 (36.4%) patients had multiple myomectomy. The mean size of the myomas removed was 5.86 +/- 3.300 cm in largest diameter (95% CI 5.56-6.16 cm). The mean weight of the myomas removed was 227.74 +/- 325.801 g (95% CI 198.03-257.45 g) and median was 100 g. The median operating time was 60 minutes (range 30-270 minutes). The median blood loss was 90 mL (range 40-2000 mL). Three comparisons were performed on the basis of size of the myomas (<10 cm and >or=10 cm in largest diameter), number of myomas removed (<or=4 and >or=5 myomas), and the technique (enucleation of the myomas by morcellation while the myoma is still attached to the uterus and the conventional technique). In all these comparisons, although the mean blood loss, duration of surgery, and hospital stay were greater in the groups in which larger myomas or more myomas were removed or the modified technique was performed as compared with their corresponding study group, the weight and size of removed myomas were also proportionately larger in these groups. Two patients were given the diagnosis of leiomyosarcoma in their histopathology and 1 patient developed a diaphragmatic parasitic myoma followed by a leiomyoma of the sigmoid colon. Six patients underwent laparoscopic hysterectomy 4 to 6 years after the surgery for recurrent myomas. One conversion to laparotomy occurred and 1 patient underwent open subtotal hysterectomy for dilutional coagulopathy.

CONCLUSION

Laparoscopic myomectomy can be performed by experienced surgeons regardless of the size, number, or location of the myomas.

Authors+Show Affiliations

Bombay Endoscopy Academy and Center for Minimally Invasive Laser Surgery Research PVT LTD, Khar, Mumbai, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18439500

Citation

Sinha, Rakesh, et al. "Laparoscopic Myomectomy: Do Size, Number, and Location of the Myomas Form Limiting Factors for Laparoscopic Myomectomy?" Journal of Minimally Invasive Gynecology, vol. 15, no. 3, 2008, pp. 292-300.
Sinha R, Hegde A, Mahajan C, et al. Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? J Minim Invasive Gynecol. 2008;15(3):292-300.
Sinha, R., Hegde, A., Mahajan, C., Dubey, N., & Sundaram, M. (2008). Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? Journal of Minimally Invasive Gynecology, 15(3), 292-300. https://doi.org/10.1016/j.jmig.2008.01.009
Sinha R, et al. Laparoscopic Myomectomy: Do Size, Number, and Location of the Myomas Form Limiting Factors for Laparoscopic Myomectomy. J Minim Invasive Gynecol. 2008 May-Jun;15(3):292-300. PubMed PMID: 18439500.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic myomectomy: do size, number, and location of the myomas form limiting factors for laparoscopic myomectomy? AU - Sinha,Rakesh, AU - Hegde,Aparna, AU - Mahajan,Chaitali, AU - Dubey,Nandita, AU - Sundaram,Meenakshi, PY - 2007/07/11/received PY - 2008/01/14/revised PY - 2008/01/30/accepted PY - 2008/4/29/pubmed PY - 2008/8/30/medline PY - 2008/4/29/entrez SP - 292 EP - 300 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 15 IS - 3 N2 - STUDY OBJECTIVE: To assess whether it is possible for an experienced laparoscopic surgeon to perform efficient laparoscopic myomectomy regardless of the size, number, and location of the myomas. DESIGN: Prospective observational study (Canadian Task Force classification II-1). SETTING: Tertiary endoscopy center. PATIENTS: A total of 505 healthy nonpregnant women with symptomatic myomas underwent laparoscopic myomectomy at our center. No exclusion criteria were based on the size, number, or location of myomas. INTERVENTIONS: Laparoscopic myomectomy and modifications of the technique: enucleation of the myoma by morcellation while it is still attached to the uterus with and without earlier devascularization. MEASUREMENTS AND MAIN RESULTS: In all, 912 myomas were removed in these 505 patients laparoscopically. The mean number of myomas removed was 1.85 +/- 5.706 (95% CI 1.72-1.98). In all, 184 (36.4%) patients had multiple myomectomy. The mean size of the myomas removed was 5.86 +/- 3.300 cm in largest diameter (95% CI 5.56-6.16 cm). The mean weight of the myomas removed was 227.74 +/- 325.801 g (95% CI 198.03-257.45 g) and median was 100 g. The median operating time was 60 minutes (range 30-270 minutes). The median blood loss was 90 mL (range 40-2000 mL). Three comparisons were performed on the basis of size of the myomas (<10 cm and >or=10 cm in largest diameter), number of myomas removed (<or=4 and >or=5 myomas), and the technique (enucleation of the myomas by morcellation while the myoma is still attached to the uterus and the conventional technique). In all these comparisons, although the mean blood loss, duration of surgery, and hospital stay were greater in the groups in which larger myomas or more myomas were removed or the modified technique was performed as compared with their corresponding study group, the weight and size of removed myomas were also proportionately larger in these groups. Two patients were given the diagnosis of leiomyosarcoma in their histopathology and 1 patient developed a diaphragmatic parasitic myoma followed by a leiomyoma of the sigmoid colon. Six patients underwent laparoscopic hysterectomy 4 to 6 years after the surgery for recurrent myomas. One conversion to laparotomy occurred and 1 patient underwent open subtotal hysterectomy for dilutional coagulopathy. CONCLUSION: Laparoscopic myomectomy can be performed by experienced surgeons regardless of the size, number, or location of the myomas. SN - 1553-4650 UR - https://www.unboundmedicine.com/medline/citation/18439500/Laparoscopic_myomectomy:_do_size_number_and_location_of_the_myomas_form_limiting_factors_for_laparoscopic_myomectomy L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(08)00079-4 DB - PRIME DP - Unbound Medicine ER -