[Comparative study of laparoscopically assisted myomectomy and mini- laparotomy for uterine intramural fibroids]

To evaluate the feasibility and safety of laparoscopically assisted myomectomy (LAM) for uterine intramural fibroids.

Thirty-seven selected patients with uterine intramural fibroids with the diameters > 5 cm and < 9 cm were subjected to LAM technique, the intramural fibroid of 2 among which penetrated into the uterine cavity (< 50%). LAM was completed with a laparoscopically assisted enucleation. After the fibroid was half-scripped, the incision of puncture point at the middle of abdominal wall was expanded to 4 approximately 5 cm in length. The scripping of the fibroid and the suture of the uterine wound were completed outside the abdominal incision. The duration of operation, blood loss, intra- and post-operation complications and time to full recovery were evaluated and comparison with those in 630 patients with hysteromyoama who underwent myomectomy by laparotomy during the same period.

The operative time in LAM group ranged from 50 min to 240 min (101 min +/- 56 min), without a significant difference in comparison with that in the group of myomectomy by laparotomy (89 min +/- 38 min, P > 0.05). However, the median of blood loss in LAM group was 50 ml, significantly less than that in the group of myomectomy by laparotomy (80 ml, P < 0.05). The incidence of pyrexia was lower and the time needed for recovery was shorter after LAM in comparison with those in the group of myomectomy by laparotomy (P < 0.001). Neither intra-operative nor post- operative complication was observed in the LAM group. Eight of the 11 cases with infertility in the LAM group were conceived at least one year after LAM. The pregnancy was uneventful and proceeded to cesarean section at the 37 approximately 38 th week.

LAM operation is feasible and safe, and offers a easy-to-perform minimally invasive myomectomy technique for intramural fibroid removal with all the advantages of laparoscopic surgery and a good reconstructive outcome.