Laparoscopic excision of very large myomas

Study Objective. To evaluate the feasibility, complications, and conversion rate of laparoscopic excision of very large myomas. Design. Prospective study (Canadian Task Force classification II-2). Setting. Private endoscopy center. Patients. Fifty-one women with at least one myoma larger than 9 cm. Intervention. Laparoscopic myomectomy. Measurements and Results. We removed 78 myomas laparoscopically in these 51 patients. Three patients had two myomas larger than 9 cm, three had two myomas between 5 and 9 cm (in addition to 1 >9 cm), and one had three myomas between 5 and 9 cm (in addition to 1 >9 cm). Mean number of myomas removed/patient was 1.53 +/- 1.17 (range 1-6); 12 women (23.5%) had multiple myomectomy. The largest myoma removed was 21 cm. Mean myoma weight was 698.47 +/- 569.13 g (range 210-3400 g). Mean operating time was 136.67 +/- 38.28 minutes (range 80-270 min). Mean blood loss was 322.16 +/- 328.2 ml (range 100-2000 ml). One patient developed a broad ligament hematoma, two developed postoperative fever, and one underwent open subtotal hysterectomy 9 hours after surgery for dilutional coagulopathy. Conclusion. Myomectomy by laparoscopy is a safe alternative to laparotomy for very large myomas.