EXPERIENCE WITH LAPAROSCOPIC LEIOMYOMA COAGULATION AND CONCOMITANT OPERATIVE HYSTEROSCOPY

Study Objectives. To evaluate the experiences of women who underwent l aparoscopic leiomyoma coagulation (myolysis) alone and those who had m yolysis in conjunction with transcervical endomyometrial resection (TE MR), transcervical electrosurgical resection of submucous leiomyomas ( TSR), or both. Design. Continuing, prospective observational study wit h mean (+/- SEM) follow-up of 36.0 +/- 1.2 months (range 18-54 mo). Se tting. Gynecology department of community and teaching hospitals. Pati ents. One hundred sixty-seven women with symptomatic leiomyomata. Inte rventions. Women complaining of pressure, pain, or both underwent only myolysis. Those with the additional symptom of chronic menorrhagia un derwent TEMR, TSR, or both. Nineteen (11.4%) of the 167 women had elec tive second-look laparoscopy 6.0 +/- 0.3 months (range 6-8 mo) later t o evaluate possible adhesion formation. Measurements and Main Results. Main outcome measures were control of symptoms, numbers and types of concomitant and subsequent procedures, changes in uterine and leiomyom ata volumes, and number of successful pregnancies. Mean total uterine volume of the 161 women decreased from 620 +/- 28.4 cm3 before leuprol ide treatment to 137 +/- 7.2 cm3 by 7 to 72 months postoperatively (p < 0.0001). Five (3.6%) women had hysterectomies for persistent or recu rrent menorrhagia, pain, pressure, or a combination of symptoms (p = 0 .01). Pathologic evaluation revealed adenomyosis, leiomyomata, or both . Of 52 women with chronic menorrhagia, 33 (63.5%) developed amenorrhe a and 17 (32.1%) developed hypomenorrhea or eumenorrhea; 2 (3.8%) requ ired repeat TEMR. The two women who desired to retain fertility had un complicated full-term pregnancies and uneventful vaginal deliveries. C onclusions. Myolysis alone or in conjunction with TEMR, TSR, or both o bviated the need for major surgery in 162 (97.0%) women. Until further studies are concluded, myolysis should be performed selectively in wo men contemplating pregnancy.