Abstract
Background
Isobaric gasless laparoscopy and minilaparotomy have been used as more recent minimally invasive approaches to myomectomy. This randomized trial aimed to compare the surgical and immediate postoperative outcomes for myomectomy performed by isobaric gasless laparoscopy with those for minilaparotomy.
Methods
A total of 100 patients with symptomatic uterine myomas requiring myomectomy were randomly allocated to the gasless laparoscopy group or the minilaparotomy group. The randomization procedure was based on a computer-generated list. The primary outcome was a comparison of the discharge times between the two procedures. A power calculation verified that more than 26 patients for each group was necessary to detect a difference of more than 24 h in discharge time with an alpha error level of 5% and a beta error of 80%. Continuous outcome variables were analyzed using the Student’s t-test. Discrete variables were analyzed with the chi-square test or Fisher’s exact test. A p value less than 0.05 was considered statistically significant.
Results
The mean discharge time was longer for minilaparotomy than for gasless laparoscopy (98.4 ± 1.4 vs 52.8 ± 1.6 h; p < 0.001). Gasless laparoscopy resulted in shorter times for canalization (21.6 ± 1.1 vs 32 ± 1.3 h; p < 0.05) and surgery (79.5 ± 25.1 vs 103.5 ± 24.9 min; p < 0.001). The intraoperative blood loss was less with gasless laparoscopy (154.2 ± 1.2 vs 188.6 ± 1.3 ml; p < 0.001). No intraoperative complications occurred, and no case was returned to the theater in either group. No conversion to standard laparotomy was necessary.
Conclusions
Isobaric gasless laparoscopy and minilaparotomy can be suitable options for uterine myomectomy. Several surgical and immediate postoperative outcomes were significantly better in the gasless laparoscopy group than in the minilaparotomy group. However, further controlled prospective studies are required to confirm the results.
Similar content being viewed by others
References
Wallach EE, Vlahos NF (2004) Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 104:393–406
Chang FH, Soong YK, Cheng PJ, Lee CL, Lai YM, Wang HS, Chou HH (1996) Laparoscopic myomectomy of large symptomatic leiomyoma using airlift gasless laparoscopy: a preliminary report. Hum Reprod 11:1427–1432
Damiani A, Melgrati L, Marziali M, Sesti F (2003) Gasless laparoscopic myomectomy: indications, surgical technique, and advantages of a new procedure for removing uterine leiomyomas. J Reprod Med 48:792–798
Benedetti-Panici P, Maneschi F, Cutillo G, Scambia G, Congiu M, Mancuso S (1996) Surgery by minilaparotomy in benign gynecologic disease. Obstet Gynecol 87:456–459
Fanfani F, Fagotti A, Longo R, Marana E, Mancuso S, Scambia G (2005) Minilaparotomy in the management of benign gynecologic disease. Eur J Obstet Gynecol Reprod Biol 119:232–236
Glasser MH (2005) Minilaparotomy myomectomy: a minimally invasive alternative for the large fibroid uterus. J Minim Invasive Gynecol 12:275–283
Damiani A, Melgrati L, Marziali M, Sesti F, Piccione E (2005) Laparoscopic myomectomy for very large myomas using an isobaric (gasless) technique. JSLS 9:434–438
Damiani A, Melgrati L, Franzoni G, Stepanyan M, Bonifacio S, Sesti F (2006) Isobaric gasless laparoscopic myomectomy for removal of large uterine leiomyomas. Surg Endosc 20:1406–1409
Fanfani F, Fagotti A, Longo R, Marana E, Mancuso S, Scambia G (2005) A prospective study of laparoscopy versus minilaparotomy in the treatment of uterine myomas. J Minim Invasive Gynecol 12:470–474
Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N (2006) Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 13:92–97
Wang CJ, Yuen LT, Lee CL, Kay N, Soong YK (2006) Laparoscopic myomectomy for large uterine fibroids: a comparative study. Surg Endosc 20:1427–1430
Dubuisson J-B, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C (2001) Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod 16:1726–1731
Dubuisson J-B, Fauconnier A, Babaki-Fard K, Chapron C (2000) Laparoscopic myomectomy: a current view. Hum Reprod Update 6:588–594
Mettler L, Alvarez-Rodas E, Semm K (1995) Myomectomy by laparoscopy: a report of 482 cases. Gynaecol Endosc 4:259–264
Reich H (1995) Laparoscopic myomectomy. Obstet Gynecol Clin North Am 22:757–780
Darai E, Deval B, Darles C, Benifla JL, Guglielmina JN, Madelenat P (1996) Myomectomie: coelioscopie ou` laparotomie. Contracept Fertil Sex 24:751–756
Seinera P, Arisio R, Decko A, Farina C, Crana F (1997) Laparoscopic myomectomy: indications, surgical technique, and complications. Hum Reprod 12:1927–1930
Ribeiro SC, Reich H, Rosenberg J, Guglielminetti E, Vidali A (1999) Laparoscopic myomectomy and pregnancy outcome in infertile patients. Fertil Steril 71:571–574
Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C, Flamigni C (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomised comparison with abdominal myomectomy. Hum Reprod 15:2663–2668
Landi S, Zoccoletti R, Ferrari L, Minelli L (2001) Laparoscopic myomectomy: technique, complications, and ultrasound scan evaluations. J Am Assoc Gynecol Laparosc 8:231–240
Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A (2001) Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod 16:770–774
Sinha R, Hegde A, Warty N, Patil N (2003) Laparoscopic excision of very large myomas. J Am Assoc Gynecol Laparosc 10:461–468
Holub Z, Jabor A, Lukac J, Kliment L, Urbanek S (2005) Laparoscopic myomectomy with lateral dissection of the uterine artery. JSLS 9:447–453
Sesti F, Melgrati L, Damiani A, Piccione E (2006) Isobaric (gasless) laparoscopic uterine myomectomy: an overview. Eur J Obstet Gynecol Reprod Biol 129:9–14
Pelosi MA II, Pelosi MA III (2004) Pelosi minilaparotomy hysterectomy: a nonendoscopic minimally invasive alternative to laparoscopy and laparotomy. Surg Technol Int 13:157–167
Benedetti-Panici P, Zullo MA, Angioli R, Muzii L (2005) Minilaparotomy hysterectomy: a valid option for the treatment of benign uterine pathologies. Eur J Obstet Gynecol Reprod Biol 119:228–231
Cagnacci A, Pirillo D, Malmusi S, Arangino S, Alessandrini C, Volpe A (2003) Early outcome of myomectomy by laparotomy, minilaparotomy, and laparoscopically assisted minilaparotomy: a randomized prospective study. Hum Reprod 18:2590–2594
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sesti, F., Capobianco, F., Capozzolo, T. et al. Isobaric gasless laparoscopy versus minilaparotomy in uterine myomectomy: a randomized trial. Surg Endosc 22, 917–923 (2008). https://doi.org/10.1007/s00464-007-9516-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9516-1