The Comparative Study Between Laparoscopic Myomectomy And Abdominal Myomectomy

Objective To compare the clinical effect between laparoscopic myomectomy and abdominal myomectomy. To investigate the selection of indications and optimal timing of surgery for laparoscopic myomectomy, and to evaluate the safety and feasibility of laparoscopic myomectomy. Methods A retrospective study of 192 women who underwent myomectomy for myomas from January 2008 to September 2010 in Shandong Provincial Qianfoshan Hospital with complete data.97 of them were treated by laparoscopic myomectomy(LM), not including the 5 cases of conversion from laparoscopic myomectomy to abdominal myomectomy(AM), and 90 were performed by abdominal myomectomy at the same time as the control group. We collected and compared the data of the both groups on operative time, decrease of hemoglobin (Hgb), analgesic use, intraoperative and postoperative complications, postoperative morbidity, hospital stay, hospitalization cost and recurrence rate. Results The operative time was (120.2±39.3) minutes in LM and (99.8±36.8)minutes in AM, which had statistical significance between the two groups(P=0.000). The decrease of hemoglobin was (1.43±0.64) g/100ml in LM and (1.74±0.74) g/100ml in AM, and there was a statistical significance between the two groups(P=0.017). The use of analgesic was 4.1% in LM and 34.4% in AM, which had statistical significance between the two groups(P=0.000). The complications and postoperative morbidity were not different between the two group. The hospital stay was (5.0±1.3) days in the LM and (6.9±1.3) days in AM, which had statistical significance between the two groups(P=0.000). The hospitalization cost was (7215.97±850.94) yuan in LM, and (6531.57±875.60) yuan in AM, which had statistical significance between the two groups(P=0.000). There were 35 cases recurred during the follow-up, the total recurrence rate was 18.2%, and 18 cases in LM, while 15 cases in AM, and the recurrence rates had no statistical significance between the two groups(18.6% vs 16.7% P=0.735).5 cases were converted from laparoscopic myomectomy to abdominal myomectomy, and the conversion rate was 4.9%, of which 2 person recurred. Conclusions①Laparoscopic myomectomy, as a minimally invasive surgery, compared with conventional abdominal myomectomy, it has smaller incision, less trauma, less drop of hemoglobin, less pain, faster recovery, shorter hospitalization days, and does not affect the appearance of abdominal. It is an ideal surgery for myomectomy, and worth to promote.②LM is still safe and feasible by selecting appropriate surgical opportunity and enlarging the surgury indications appropriately on condition that following the principle of LM, and more and more people can benefit from it. LM does not increase the recurrence rate of myoma compared with AM after surgery.③There are still some limitations for laparoscopic myomectomy, and it can't take the place of abdominal myomectomy, and in some cases it is necessary to convert from LM to AM.