Real-world comparison of minilaparotomy versus laparoscopy-assisted minilaparotomy myomectomy for complex uterine myomas.

OBJECTIVE

To directly compare perioperative and one-year postoperative outcomes of minilaparotomy myomectomy (MM) and laparoscopy-assisted minilaparotomy myomectomy (LAM) in managing complex uterine myomas.

METHODS

This retrospective study included 140 patients who underwent MM (n = 55) or LAM (n = 85) between 2015 and 2023 at a tertiary center. Demographic data, surgical outcomes, and one-year postoperative evaluations were analyzed. Multivariable linear regression identified factors associated with operative time and blood loss.

RESULTS

Preoperative characteristics and myoma burden were comparable (mean 3.49 myomas; maximum 8.3 cm). MM had shorter operative time and hospital stay (both p < .001). Three MM cases required wound extension, while no conversions occurred in the LAM group (p = .030). Over 92% of patients achieved symptom resolution at one year, with similar rates of residual myoma and reoperation. LAM use, adhesions, myoma number, and myoma size predicted longer operative time, whereas blood loss correlated with wound size, myoma number and size, and intraligamentous type.

CONCLUSION

Both MM and LAM are effective surgical options for complex myomas, with favorable perioperative and one-year outcomes. These findings support their broader clinical use and offer practical insights for surgical decision-making.