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Abdominal myomectomy--a safe procedure in an ambulatory setting
Robin L Thomas1, Nurit Winkler, Bruce R Carr
1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA. robin.thomas@utsouthwestern.edu
Objective:
To evaluate the efficacy and safety of minilaparotomy myomectomy in an ambulatory setting.
Design:
Retrospective, nonrandomized study.
Setting:
Center for Assisted Reproduction, Bedford, Texas.
Patient(S):
One hundred eighty-nine women desiring fertility with symptomatic uterine leiomyomata.
Intervention(S):
Minilaparotomy myomectomy in an ambulatory setting.
Main Outcome Measure(S):
Operative time, blood loss, recovery time, postoperative analgesia, and complications.
Result(S):
The mean diameter of the largest leiomyoma was 4.4 cm (range, 1-14 cm). The mean number and weight of the leiomyomata was 4.9 (range, 1-35) and 109.8 gm (range, 1-1,165 g), respectively. The mean operative time was 73 minutes, and the mean blood loss was 96 mL. On average, patients required 3.5 hours of recovery time. In the recovery room, patients received a mean of 12 mg of morphine/37 mg of meperidine for pain control postoperatively before discharge home. Only one major complication, pulmonary edema related to extubation, occurred.
Conclusion(S):
This study demonstrates that minilaparotomy myomectomy, when performed using a systematic operative technique, can be accomplished in an outpatient setting with minimal blood loss, fast recovery time, and a low complication rate. Postoperatively, patients require minimal analgesia, which permits them to be discharged home the same day. Minilaparotomy myomectomy is a safe, cost-effective treatment of most symptomatic uterine leiomyomata in an ambulatory setting.
