Laparoscopic Outpatient Treatment of Large Myomas

We compared laparoscopic myomectomies based on location of surgery (outpatient vs hospital), length of stay (outpatient vs hospital), time to return to normal activities, and complications. The length of surgery was evaluated with regard to fibroid size and type of morcellation (manual vs automatic). We also compared the length of time required for surgery for comparable cases using the laparoscopic and the open approaches, and evaluated the length of stay due to complications in these two subsets. Finally, we compared the automatic morcellating device with manual morcellation. The subjects were 50 women with myomas ranging in size from 20 to 500 g. In 40% of patients surgery was performed on an outpatient basis with discharge the same day, and in 60% it was performed in the hospital with a stay of 1 or 2 days. The outcomes were compared, and the laparoscopic procedures were then compared with open procedures performed by other surgeons at the same hospital for length of stay, complications, and return to normal activities. Outpatient therapy proved as safe and effective as hospital-based therapy and provided some time savings in the operating room. Length of stay appeared to be related to where the surgery was performed: patients treated in the outpatient surgical center required a much shorter stay than those treated in the hospital, and hospital laparoscopic surgery required a much shorter stay than hospital exploratory surgery. Women who underwent laparoscopic myomectomy experienced less blood loss and fewer complications than those undergoing the standard exploratory laparotomy approach to myomas. The automatic morcellator reduced operating room time by a minimum of 45 minutes; resection of fibroids larger than 300 g requires patience and time for the operating room staff but results in no increased morbidity, and the patients are discharged home equally as soon as outpatients or within 2 days if the surgery is performed in the hospital. Laparoscopic myomectomies, even for myomas of 500 g, can be performed safely in an outpatient setting. The automatic morcellator provides significant savings in operating room time and is a cost-effective application of new technology.