Treatment of myomas by laparoscopic and laparotomic myomectomy and laparoscopic hysterectomy

The objective of this study was to evaluate the benefits, feasibility and limitations of laparoscopic myomectomy. It was a retrospective review (Canadian Task Force Classification II-2) at a university-based primary treatment centre for endoscopic surgery. The 216 evaluated patients were treated at the Department of Obstetrics and Gynaecology, University of Kiel, between January 1998 and November 2000. Of 216 patients with myomas, 178 (83%) underwent laparoscopic myomectomy, 27 (12%) laparoscopic hysterectomy and 11 (5%) laparotomic myomectomy. The study reviewed the indications and surgical techniques and evaluated the benefits and limitations of laparoscopic myomectomy. Nine patients were selected for Classic Intrafascial Supracervical Hysterectomy (CISH) and 18 for Laparoscopic Assisted Vaginal Hysterectomy (LAVH), i.e. 12% of the patients were selected for laparoscopic hysterectomy. In an additional 11 (5%) patients the laparoscopic approach was difficult because of the location of the myoma and the procedure converted to a laparotomic myomectomy. A total of 178 patients (83%) was treated by laparoscopic myomectomy. The mean hospital stay was three days. No serious complications occurred. Two patients suffered a uterine wound bleeding which was corrected and one patient an abdominal hematoma. Since this study mainly focuses on laparoscopic myomectomies (83%), hysteroscopic myomectomies were evaluated in a separate study. At our institution laparoscopic myomectomy is the first-step treatment for patients with myomatous uteri. Only a small percentage of patients had to undergo a laparotomy (5%) and for 27 patients (12%) hysterectomy proved to be the treatment of choice.