Abstract
This study was performed to evaluate the advantages of the technique of laparoscopic myomectomy combined with preventive uterine artery occlusion. A nonrandomized comparative study was performed on two groups. Between January 2001 and February 2003 two groups of 53 patients each underwent laparoscopic myomectomy: one group with preventive uterine artery occlusion (G1) and the other without preventive uterine artery occlusion (G2). Four criteria were designated for comparison: number of removed myomas (2.2 ± 1.7 in G1, 1.8 ± 1.2 in G2; p = 0.2610), size (66 ± 25.42 mm in G1, 64 ± 22.5 mm in G2; p = 0.6701), type (p = 0.888), and location (p = 0.1085) of the biggest myoma. Laparoscopic myomectomy was successfully completed in all cases. The mean operating time was 153.3 ± 40.6 minutes for G1 and 137.1 ± 49.4 minutes for G2 (p = 0.0725). The average hospital stay was 3 ± 1.8 days for G1 and 2.9 ± 1.1 days for G2 (p = 0.5986). The mean hemoglobin decrease (pre- and postoperative) was 1.8 ± 1.2 g/dL for G1 and 2.1 ± 2.2 g/dL for G2 (p = 0.2374). The postoperative hemoglobin mean was 11.4 ± 1.5 g/dL for G1 and 10.6 ± 1.6 g/dL for G2 (p = 0.0169). Hemoglobin drop >3 g/dL was observed in 2 out of 48 patients in G1 and in 10 out of 47 patients in G2 (p = 0.0121). Conversions to laparotomy were only noted for G2 (n = 6, 11.3%; p = 0.0117). In the group combining laparoscopic myomectomy with preventive uterine artery occlusion, the postoperative hemoglobin rate was higher, the hemoglobin drop >3 g/dL and the conversion rate to laparotomy was lower. Therefore, we recommend performing preventive uterine artery occlusion in cases of large vascularized myomas in order to facilitate the myoma enucleation and the myometrium suture. These preliminary results should be confirmed in a larger study. (J GYNECOL SURG 20:105)
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