Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study
Cagnacci, A.; Pirillo, D.; Malmusi, S.; Arangino, S.; Alessandrini, C.; Volpe, A.
Human Reproduction 18(12): 2590-2594
2003
ISSN/ISBN: 0268-1161 PMID: 14645175 DOI: 10.1093/humrep/deg478Document Number: 393100
BACKGROUND: To compare in the first 7 days after surgery the outcome of myomectomy performed by three laparotomic approaches: laparotomy (LT), minilaparotomy (MLT) and laparoscopically assisted minilaparotomy (LA-MLT). METHODS: Fifty-one women with 5-15 cm total myoma diameter were randomized blindly using a computer randomization list, to LT (n = 17), MLT (n = 17) or LA-MLT (n = 17). RESULTS: Mean operation length was similar in the three groups. Mean (+- SEM) time of paralytic ileus (55.0 +- 4.5 versus 33.4 +- 3.4 h; P < 0.01) and discharge (141.6 +- 5.2 versus 81.5 +- 8.2 h; P < 0.01) was longer in LT than LA-MLT or even MLT. In comparison with LA-MLT, LT induced a greater haemoglobin decline (-3.07 +- 0.3 versus -1.8 +- 0.15 mg/dl; P < 0.025), and a greater post-operative stress, as documented by increased prolactin (+15.1 +- 3.8 versus +0.16 +- 4.5 ng/ml; P < 0.03) and decreased insulin sensitivity (fasting glucose/insulin; -7.5 +- 2.6 versus -0.7 +- 2.1; P < 0.02). Seven days after surgery, abdominal pain (P < 0.05) was higher after LT (3.0 +- 0.6) than MLT (0.5 +- 0.2) and LA-MLT (0.9 +- 0.4). CONCLUSIONS: In selected cases, myomectomy by LA-MLT offers some advantages versus LT and, to a smaller extent, MLT.