123: Italian Multicenter Study on Complications of Laparoscopic Myomectomy

Abstract

To study intra- and post-operative complications of laparoscopic myomectomy in four Italian referral centers. Prospective study. The incidence and type of complications occurring in 2051 laparoscopic myomectomies undertaken in four Centers from January 1998 to December 2004, were recorded in a prospective study, with a retrospective review of the patient records by the first author. We performed 2051 single or multiple myomectomies for symptomatic myomas measuring at least 4 centimeters in diameter. Most patients (48%) had more than one myoma, with a maximum of fifteen per patient (average myomas removed for patients: 2.25±1.8 DS (range 1–15). Myoma size ranged from 1 to 20 cm (average 6.4 ± 2.6 DS). Myomas smaller than 4 cm were removed during myomectomy for larger ones. Surgical technique was the same for the four centers as well expertise of the operators. Injection of vasoconstrictive agents was used in 37 %. The serosa were always incised in a vertical fashion; mechanical enucleation of the myoma was completed whenever possible; suture was performed in one or two layers with deep and large stitches swaged to 1 or 0 Polyglactin sutures which were tied intracorporeally or extracorporeally. Total complication rate was 10.5%. Minor complications (fever, cystitis, and lesions due to uterine manipulator) accounted for 51%, while major complications for 49%. Most serious events were hemorrhages (14 cases, 0.68%) with requirement of blood transfusions in three cases (0.14%); ten post-operative hematomas (0.48%, one in the broad ligament and 9 in the myomectomy scar); one bowel injury; one postoperative acute renal failure due to constant hypotension during surgery; and two unexpected sarcomas (0.09%). Failure to complete planned surgery occurred in 7 cases (0.94%). Two patients were readmitted to surgery room. This is one of the largest series reported of laparoscopic myomectomy and the first focused on complications. The complication rate appears to be more than acceptable in comparison with complication rates reported after laparotomic myomectomies. Laparoscopic myomectomy, when performed by an experienced surgeon, can be considered a safe technique with a failure rate and good results in term of pregnancy outcome.