Experience with laparoscopic leiomyoma coagulation and concomitant operative hysteroscopy

Phillips DR, D R Phillips, Douglas R. Phillips, Steven J. Milim, Milim SJ, S J Milim, Nathanson HG, H G Nathanson, Howard G. Nathanson, J S Haselkorn, Haselkorn JS, Joan S. Haselkorn
The Journal of the American Association of Gynecologic Laparoscopists · 1997 · vol. 4(4) , pp. 425–433 · doi:10.1016/s1074-3804(05)80034-9 · PMID:9224575 · W2062200792
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This paper reviews the authors' experience with laparoscopic leiomyoma coagulation and concomitant operative hysteroscopy for treating uterine fibroids.

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Abstract

Study objectivesTo evaluate the experiences of women who underwent laparoscopic leiomyoma coagulation (myolysis) alone and those who had myolysis in conjunction with transcervical endomyometrial resection (TEMR), transcervical electrosurgical resection of submucous leiomyomas (TSR), or both.DesignContinuing, prospective observational study with mean (+/- SEM) follow-up of 36.0 +/- 1.2 months (range 18-54 mo).SettingGynecology department of community and teaching hospitals.PatientsOne hundred sixty-seven women with symptomatic leiomyomata.InterventionsWomen complaining of pressure, pain, or both underwent only myolysis. Those with the additional symptom of chronic menorrhagia underwent TEMR, TSR, or both. Nineteen (11.4%) of the 167 women had elective second-look laparoscopy 6.0 +/- 0.3 months (range 6-8 mo) later to evaluate possible adhesion formation.Measurements and main resultsMain outcome measures were control of symptoms, numbers and types of concomitant and subsequent procedures, changes in uterine and leiomyomata volumes, and number of successful pregnancies. Mean total uterine volume of the 167 women decreased from 620 +/- 28.4 cm3 before leuprolide treatment to 131 +/- 7.2 cm3 by 7 to 12 months postoperatively (p <0.0001). Five (3.6%) women had hysterectomies for persistent or recurrent menorrhagia, pain, pressure, or a combination of symptoms (p = 0.01). Pathologic evaluation revealed adenomyosis, leiomyomata, or both. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea and 17 (32.7%) developed hypomenorrhea or eumenorrhea; 2 (3.8%) required repeat TEMR. The two women who desired to retain fertility had uncomplicated full-term pregnancies and uneventful vaginal deliveries.ConclusionsMyolysis alone or in conjunction with TEMR, TSR, or both obviated the need for major surgery in 162 (97.0%) women. Until further studies are concluded, myolysis should be performed selectively in women contemplating pregnancy.

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MeSH descriptors

Hysteroscopy Laparoscopy Laparoscopy Laser Coagulation Laser Coagulation Leiomyoma Uterine Neoplasms Adult Electrosurgery Endometrium Endometrium Female Humans Hysterectomy Leiomyoma Myometrium Myometrium Postoperative Complications Pregnancy Preoperative Care

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