Laparoscopic myomectomy in treatment of large myomas

Laparoscopic myomectomy was evaluated in 178 women, most of whom underwent the procedure for infertility or other gynecologic disorders associated with myomas (endometriosis, ovarian masses, genital malformations, tubal obstruction, etc.). In 28 (17.5%) patients the indication was the myoma itself, associated with pain, menorrhagia, miscarriage, or continued growth. The sizes of myomas ranged from 7 to 16 cm. Twenty-one women (75%) had only one myoma, but seven (25%) had two to eight (average 5). The myomas were prevalently interstitial and subserous. Myomectomies were performed with conventional techniques. No vasoconstricting preparations were used. All uterine wall defects were sutured with extracorporeal knot tying. Myomas were removed from the peritoneal cavity by morcellation or through a posterior colpotomy. Operating time ranged from 70 to 200 minutes (average 105 min); long cases were mostly due to the process of removing the myomas from the peritoneal cavity. Blood loss ranged from 20 to 250 ml (average 56 ml). We believe that laparoscopy is effective for myomectomy, even large myomas, but its advantages are still to be established based on long-term outcomes, especially with respect to adhesion formation and restoration of fertility.