A comparison of combined laparoscopic uterine artery ligation and myomectomy versus laparoscopic myomectomy in treatment of symptomatic myoma

Objective: To evaluate the efficacy of uterine artery ligation before laparoscopic myomectomy compared with myomectomy alone. Design: Prospective controlled, clinical trial. Setting: Private and Shiraz University-affiliated hospitals. Patient(s): Of 152 women with symptomatic uterine myomas necessitating surgical intervention who wished to retain their uteri, 65 underwent laparoscopic uterine artery ligation and myomectomy (experimental group) and 87 received laparoscopic myomectomy only (control group). Intervention(s): Ligation of the uterine arteries before laparoscopic myomectomy. Main Outcome Measure(s): Operating time, blood loss, blood transfusion, febrile morbidity, symptoms improvement, recurrence rate, and pregnancy rate. Result(s): The average operating time and blood loss were 112 +/- 18 minutes and 173 +/- 91 mL for the experimental group and 95 +/- 14 minutes and 402 +/- 131 mL for the control group, respectively (statistically significant). A total of 15 (17.2%) of the control group patients required a blood transfusion, but none of the experimental group patients required one. Febrile morbidity occurred in 18.5% of the experimental group and 20.7% of the control group. In the experimental group, the recurrence of myoma was 6.2%, and 98.1% of the patients reported symptoms improvement; however, in the control group, these figures were 20.75% and 83.1%, respectively (statistically significant). The pregnancy rates were not statistically significantly different in the experimental group (35%) and the control group (35.7%). Conclusion(s): This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas. (Fertil Steril (R) 2009;92:742-7. (C)2009 by American Society for Reproductive Medicine.)