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Laparoscopic versus laparoscopically-assisted myomectomy: An institutional experience

Maria Reichenber C. Arcilla, MD, FPOGS; Grace B. Caras-Torres, MD, FPOGS, FPSRM, FPSGE and Delfin A. Tan, MD, FPOGS, FPSRM, FPSGE
Department of Obstetrics and Gynecology, St. Luke's Medical Center - Quezon City

Background: Uterine fibroids are the most common benign tumors in women. Management of symptomatic fibroids may ultimately require surgery and for those desirous of fertility, laparoscopically assisted myomectomy and the conventional laparoscopic procedure are conservative treatment options, with the former providing a less technically demanding approach.

Objectives: This study aims to evaluate the clinical outcomes for laparoscopically assisted myomectomy (LAM) versus laparoscopic myomectomy (LM) done at a tertiary hospital.

Methods: This is a retrospective chart review of 118 patients with symptomatic myomas who underwent LM (n=66) or LAM (n=52) at a tertiary hospital from January 2010 to December 2017.

Results: There were significantly more fibroids removed in the LAM group compared to the LM group, but with no significant difference in the average diameter of fibroid removed. Complex plastic reconstruction with more than 2 layers of repair was done more often in the LAM group (p<0.001). The mean operative time was longer and more blood loss was incurred in the LM group, but this was not statistically significant. Almost 14% of patients in the LM group had blood transfusion compared to 4.1% in the LAM group (p=0.085). The rate of perioperative complications was similar for both groups. The length of hospital stay was shorter in the LM group, but was not statistically significant. A trend towards higher odds of pregnancy was seen in the LAM group. Majority of patients were delivered via cesarean section with no incidence of uterine rupture. The recurrence of fibroids was seen more in the LAM group (17.9% versus 13.7% for LM), however this was not statistically significant.

Conclusions: The surgical, reproductive, and long-term clinical outcomes for both LAM and LM are similar, thus, LAM provides a non-inferior minimally invasive approach and a conservative option for patients desirous of future fertility.