Recurrence factors and reproductive outcomes of laparoscopic myomectomy and minilaparotomic myomectomy for uterine leiomyomas

Abstract

ObjectiveThe aim of this study was to determine recurrence factors and reproductive outcomes of laparoscopic myomectomy (LM) and minilaparotomic myomectomy (MM) for treating uterine leiomyomas.MethodsBetween 2007 and 2013, 160 patients underwent myomectomy, including 122 who underwent LM and 38 who underwent MM. Patients were followed up for recurrence based on pelvic ultrasound exams. Only patients who were followed up for a minimum of two years were selected for this retrospective study. Pregnancy rate, delivery, and delivery methods were compared between the two groups to evaluate reproductive outcomes. Furthermore, mean age, body mass index, preoperative administration of gonadotropin-releasing hormone agonist (GnRHa), and characteristics of leiomyomas were investigated to determine recurrence factors.ResultsThe mean body mass index in the MM group was significantly (P=0.048) higher than that in the LM group. The number and the largest diameter of removed leiomyoma were also significantly higher in the MM group (both P=0.001). Logistic regression after adjusting significantly different characteristics showed that the LM group had shorter (P=0.020) postoperative hospitalization days compared to the MM group. Other outcome variables including recurrence rate were not significantly different between the two groups. Reproductive outcomes such as pregnancy rate, delivery, and delivery methods were not significantly different between the two groups. Preoperative GnRHa therapy was the only significant (P=0.039) recurrence factor after myomectomy.ConclusionThis study showed that LM and MM had similar recurrence rates and reproductive outcomes. The only recurrence factor of significance was preoperative administration of GnRHa.

Analysis of risk factors for postoperative bleeding and recurrence after laparoscopic myomectomy in patients with uterine fibroids: a retrospective cohort study

“…Clinically, pre-treatment with Gn RH-a before surgery can be used for patients with anemia or excessive fibroid volumes to correct anemia or reduce fibroid volume, thus reducing the occurrence of surgical complications ( 28 ). However, other studies have recently shown that treatment with Gn RH-a before fibroid resection leads to an increased risk of recurrence in patients, which may be because Gn RH-a reduces the volume of preoperative fibroids and affects the identification of small fibroids during surgery ( 31 , 32 ) and leads to incomplete intraoperative fibroid resection. This suggests that we should be more meticulous in preoperative and intraoperative color Doppler ultrasonography, strictly control the surgical indications, and select an appropriate surgical plan accordingly to improve the safety and effectiveness of surgery, to reduce the possibility of postoperative recurrence ( 33 ).…”

Tips and Details for Successful Robotic Myomectomy: Single-Center Experience with the First 125 Cases

“…Laparoscopy is the most common surgical modality used by gynecologists [ 10 ]. Most scholars believe that patients with fibroids larger than 10 cm in diameter, more than 4 in number, and close to submucosal fibroids, as well as cervical fibroids, are relative contraindications to laparoscopic surgery, causing difficulty and even complications [ 38 , 39 , 40 ]. Robot-assisted systems have their own unique advantages.…”

The Influence of Intraoperative Ultrasound Monitoring on the Risk of Recurrence and Reoperation in Patients with Hysteromyomectomy

“…Uterine fibroids are common benign tumors of the female reproductive system, mostly in women of childbearing age, with an incidence of up to 40% [ 1 ]. It is mainly caused by the proliferation of smooth muscle cells, formed by fibrous connective tissue, and, can cause irregular vaginal bleeding in female patients, menorrhagia, pelvic pain, frequent urination, constipation, abortion, and infertility and other symptoms.…”