LAPAROSCOPIC MYOMECTOMY - INDICATIONS, SURGICAL TECHNIQUE AND COMPLICATIONS

The indications and complications of laparoscopic myomectomy were eval uated with regard to its limitations, benefits and feasibility, Surgic al technique with related difficulty was also reported, From a populat ion of 89 patients, a total of 104 myomas were removed laparoscopicall y, A retrospective study was carried out of 54 patients with myomas >3 cm, Indications for surgery were pain or abnormal bleeding (37%), inc rease in size of the myoma in infertile patients (48.1%) and infertili ty requiring assisted reproductive technology (14.9%), A total of 57 m yomas >3 cm were removed from these patients, The number of myomas per patient varied from 1 to 4, The myomas were intramural (n = 34), subs erosal (n = 19) and submucosal (n = 4), The size of the dominant myoma ranged from 3-8 cm (mean 4.16), In all cases the uterine wall was sut ured either in one (n = 42) or two planes (n = 15) depending on the de pth of the myometrial defect, The laparotomy conversion rate was 1.8% (n = 1); mean blood loss was 84 mi; average hospital stay was 2.09 day s and the overall complication rate was 1.8%, Five patients went on to conceive; the pregnancy was uneventful and proceeded to Caesarean sec tion at 38 weeks. No adhesions at myomectomy sites were observed in th ese patients, At 6 months follow-up, 18 out of 20 patients with pain o r haemorrhagic disorders prior to surgery showed remission of their co mplaints, Our study confirms the feasibility of laparoscopic myomectom y as a technique leading to a low complication rate and remission of s ymptoms, At the present time, statistically significant data concernin g postsurgical adhesion formation or pregnancy outcome are not availab le.