Laparoscopic Leiomyoma Coagulation

From February 1992 through March 1995, 167 women (mean ± SEM age 44.7 ± 0.3 yrs, range 22-52 yrs) with symptomatic leiomyomata underwent laparoscopic leiomyoma bipolar coagulation. Women with chronic menorrhagia had concomitant transcervical endometrial resection (TEMR) and resection of any existing submucous leiomyomas (TSR). Follow-up was 30.2 ± 1.0 months (range 12-49 mo). Depot leuprolide acetate was administered for 3 months before surgery to 164 (98.2%) of the patients. The surgical procedure was evaluated in terms of numbers and types of concomitant procedures, whether or not symptoms were controlled, and changes in uterine and leiomyomata volumes. Mean total uterine volume decreased from 623 cm3 before leuprolide treatment to 139 cm3, a 77.7% reduction, 7 to 12 months postoperatively (p <0.0001). Six women (3.6%) had hysterectomy for recurrent menorrhagia, pain, and pressure; pathologic evaluation revealed adenomyosis or leiomyomata or both. Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhea, 17 (32.7%) had hypomenorrhea or eumenorrhea, and 2 (3.8%) required repeat TEMR. The two women who desired fertility had uncomplicated viable full-term pregnancies and delivered vaginally. Laparoscopic myolysis alone or in conjunction with TEMR and TSR obviated the need for major surgery in 161 patients (96.4%). Until further studies are concluded, only selected women contemplating pregnancy should undergo myolysis.