Laparoscopic excision of very large myomas.

STUDY

OBJECTIVE

To evaluate the feasibility, complications, and conversion rate of laparoscopic excision of very large myomas.

DESIGN

Prospective study (Canadian Task Force classification II-2).

SETTING

Private endoscopy center.

PATIENTS: Fifty-one women with at least one myoma larger than 9 cm.

INTERVENTION: Laparoscopic myomectomy.

MEASUREMENTS AND

RESULTS

We removed 78 myomas laparoscopically in these 51 patients. Three patients had two myomas larger than 9 cm, three had two myomas between 5 and 9 cm (in addition to 1 > 9 cm), and one had three myomas between 5 and 9 cm (in addition to 1 > 9 cm). Mean number of myomas removed/patient was 1.53 +/- 1.17 (range 1-6); 12 women (23.5%) had multiple myomectomy. The largest myoma removed was 21 cm. Mean myoma weight was 698.47 +/- 569.13 g (range 210-3400 g). Mean operating time was 136.67 +/- 38.28 minutes (range 80-270 min). Mean blood loss was 322.16 +/- 328.2 ml (range 100-2000 ml). One patient developed a broad ligament hematoma, two developed postoperative fever, and one underwent open subtotal hysterectomy 9 hours after surgery for dilutional coagulopathy.

CONCLUSION

Myomectomy by laparoscopy is a safe alternative to laparotomy for very large myomas.