IMR Press / EJGO / Volume 24 / Issue 1 / pii/2003119

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Case Report

Fertility after laparoscopic myomectomy of large uterine myomas: operative technique and preliminary results

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1 Malzoni Medical Center “Villa dei Platani”, Avellino, Italy
2 Obstetrics and Gynecology Institute, Second University of Naples, Italy
3 Division of Advanced Laparoscopic Surgery, Columbia University - New York, USA
Eur. J. Gynaecol. Oncol. 2003, 24(1), 79–82;
Published: 10 February 2003

Objective: The purpose of this study was to evaluate indications and complications of laparoscopic myomectomy with regard to the reproductive outcome of infertile women with a large leiomyomatous uterus. Methods: From January 1997 to July 1999, 144 patients underwent laparoscopic myomectomy for a myoma measuring ≥5 cm in diameter. Indications for surgery were increase in size of myoma in infertile patients (70.8%), pain (44.4%) or abnormal bleeding (68%). Average size of myomas were 7.8 cm with a range of 5 cm to 18 cm. The myomas were intramural/submucosal (n = 108), subserosal (n = 15), intraligamentous (n = 14) and peduncolated (n = 7). The laparotomy conversion rate was 1.39% (n = 2); one case required a blood transfusion. Operating time ranged from 58 to 180 minutes with an average of 95 minutes. Average hospital tay was 2.6 days and the overall complication rate was 2.08%. Eighteen patients (12.5%) underwent second-look laparoscopy. The rate of postoperative adhesion was 33.3%; there were no adnexal adhesions. In all cases ultrasonography was done one day after the operation and five weeks postoperatively to compare wound -healing, the last control showed an irregular hypodense area in only 14 patients (9.7%). Results: Twenty-six patients operated on in 1997 went on to conceive: nine vaginal deliveries, 12 Caesarean sections, four miscar­riages and one ectopic pregnancy. No uterine rupture was observed. The pregnancy rate for patients submitted to laparoscopic myo­mectomy in 1997 (n = 38) was 34.21% at six months (n = 13) and 55.26% (n = 21) at 12 months after the procedures. Conclusions: Our preliminary results confirm that conception occurs in the majority of infertile women with a large leiomyomatous uterus who undergo myomectomy and second-look laparoscopy leads to a low complication rate.

Laparoscopic myomectomy
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