Patient Selection for Myomectomy via Operative Laparoscopy

Removal of uterine myomas via operative laparoscopy is controversial. The ability to select patients who are likely to be successfully managed by this approach would eliminate unnecessary morbidity and extended operative times. We studied the ability of clinical examination, ultrasound evaluation, hysteroscopy, and laparoscopic assessment of the uterus to select appropriate candidates for operative laparoscopy. Candidates were women who requested myomectomy, who had uterine size less than 14 weeks on initial examination, who had no myoma greater than 7 cm after 3 months of GnRH agonist, and who were surgical candidates. Forty-two patients were entered into the study. Twenty patients were believed to be candidates for operative laparoscopy. They were all successfully operated on without conversion to laparotomy and without complications. Initial clinical examination and/or ultrasound and laparoscopic assessment of the uterus at the time of surgery were found to be the best predictors of successful operative laparoscopy. Magnetic resonance imaging is helpful in patients who desire fertility. All four patients who attempted pregnancy conceived. Three delivered at term by Cesarean section and one had a spontaneous abortion.