Laparoscopic excision of very large myomas

Area of Science:

• Minimally invasive gynecologic surgery
• Reproductive medicine
• Surgical oncology

Background:

• Uterine fibroids (myomas) are common benign tumors that can cause significant symptoms.
• Very large myomas often necessitate open surgery (laparotomy), which carries higher morbidity.
• Laparoscopic myomectomy has been explored for smaller fibroids, but its feasibility for very large ones is less established.

Purpose of the Study:

• To assess the feasibility of laparoscopic excision for very large myomas (>9 cm).
• To evaluate the complication rates associated with this minimally invasive approach.
• To determine the conversion rate to open surgery.

Main Methods:

• Prospective study conducted in a private endoscopy center.
• Inclusion of 51 women with at least one myoma larger than 9 cm.
• Performance of laparoscopic myomectomy, with detailed recording of myoma size, weight, operative time, blood loss, and complications.

Main Results:

• Successfully removed 78 myomas laparoscopically from 51 patients, with the largest measuring 21 cm and mean weight of 698.47 g.
• Mean operative time was 136.67 minutes with mean blood loss of 322.16 ml.
• A low complication rate was observed, including one conversion to open hysterectomy due to coagulopathy.

Conclusions:

• Laparoscopic myomectomy is a safe and feasible alternative to laparotomy for the treatment of very large uterine fibroids.
• This minimally invasive technique can be successfully applied to complex cases, offering potential benefits over open surgery.