Endoscopic management of uterine myoma

This study was undertaken to evaluate the various gynecologic endoscopic su rgical techniques including resectoscopic myomectomy, laparoscopic myomecto my, and laparoscopy assisted vaginal hysterectomy (LAVH) used in the treatm ent of uterine myomas. The medical records of 136 cases of uterine myomas t reated using one or more of the gynecologic endoscopic surgical techniques in the Department of Obstetrics and Gynecology at Yonsei University were re trospectively reviewed from March 1997 to September 1998. Of the 136 cases reviewed, there were 40 submucosal myomas and 96 intramural and subserosal myomas. For statistical analysis, Student's t-test: was used. Submucosal my omectomy using the resectosope was performed in 35 cases (mean age: 33+/-1. 5 years), laparoscopic myomecotmy in 35 cases (mean age: 36+/-1.3 years), a nd LAVH in 66 cases (mean age: 42+/-1.1 years). In cases of huge myomas, th e GnRH agonist was used prior to surgery, and in cases of heavy uterine ble eding, angioblock bi:che uterine artery was undertaken before the endoscopi c procedures. The mean operating time was significantly shorter in resectos copic myomectomy (41+/-12 min), followed by laparoscope myomectomy (85.0+/- 10.3 min) and LAVH (123+/-5.3 min). The mean hospital stay for resectoscopi c myomectomy, laparoscopic myomectomy, and LAVH was 1.9+/-0.5, 2.5+/-0.5, a nd 3.4+/-0.8 days (p < 0.001), respectively. There were 3 cases of complica tions including pulmonary edema and uterine perforation in the resectoscopi c myomectomy group, and 4 cases of complications including bladder, ureter, and epigastric vessel injury in the LAVH group. In conclusion, the therape utic effect of various gynecologic endoscopic surgical techniques can be ma ximized in terms of shorter operation rime, shorter hospital slay, faster r ecovery, and less blood loss by the appropriate management of uterine myoma in well-chosen patients.