Application and Clinical Results of Minimally Invasive Surgery in Patients with Uterine Fibroids: A Single-Centre Study in Azerbaijan

Abstract

Objective: This single-centre retrospective study aimed to evaluate the efficacy, safety, and clinical outcomes of laparoscopic myomectomy laparoscopic myomectomy (LM) for uterine fibroids in a resource limited clinical setting. Materials and Methods: The medical records of 406 patients with uterine leiomyomas who underwent laparoscopic myomectomy between 2019 and 2024 were analyzed. Data included myoma characteristics (localization, number, and size), intraoperative parameters, complications, and postoperative outcomes (symptom resolution and fertility rates). Results: Among the 406 procedures, most patients were nulliparous (81.8%) and presented with abnormal uterine bleeding (69.7%). The mean diameter of the largest fibroid was 6.2 ± 2.1 cm, with a range of 3–10 cm, with solitary fibroids in 62.3% of cases. Subserosal (48.1%) and intramural (41.4%) localizations were the most common. Intraoperative blood loss was <100 mL in 52.5% of the cases. Laparoscopic resection was successfully completed in 394 cases (97.0%), while 12 cases (3.0%) required conversion to laparotomy due to dense adhesions, intraoperative hemorrhage, or technical limitations. At the 12-month follow-up, symptom resolution rates were 92.1% for bleeding, 88.6% for pelvic pressure, and 76.9% for infertility, with 33.3% of fertility-seeking patients achieving pregnancy. Conclusion: Laparoscopic myomectomy demonstrated safety and efficacy as a primary treatment for uterine fibroids in resource-limited settings, with high symptom resolution and favorable fertility out comes. This minimally invasive approach should be prioritized where surgical expertise is available, even in low-equipment environments.

Keywords

• Minimally invasive surgery
• Uterine fibroids
• Laparoscopic myomectomy
• Fertility preservation
• Resource-limited settings

References

1. 1. Yang Q, Ciebiera M, Bariani MV, Ali M, Elkafas H, Boyer TG, et al. Comprehensive review of uterine fibroids: developmental origin, pathogenesis, and treatment. Endocr Rev 2022; 43(4): 678-719. google scholar
2. 2. Stewart EA, Nowak RA. Uterine fibroids: hiding in plain sight. Physiology (Bethesda) 2022; 37(1): 16-27. google scholar
3. 3. Sundermann AC, Velez Edwards DR, Bray MJ, Jones SH, Latham SM, Hartmann KE. Leiomyomas in pregnancy and spontaneous abortion: a systematic review and meta-analysis. Obstet Gynecol 2017; 130(5): 1065-72. google scholar
4. 4. Li YT, Yeh CC, Chao HT, Wang PH. Preservation of the uterus. Taiwan J Obstet Gynecol 2015; 54(6): 799-800. google scholar
5. 5. Fonseca MCM, Castro R, Machado M, Conte T, Girao M. Uterine artery embolization and surgical methods for the treatment of symptomatic uterine leiomyomas: a systemic review and meta-analysis followed by indirect treatment comparison. Clin Ther 2017; 39(7): 1438-55.e2. google scholar
6. 6. Havryliuk Y, Setton R, Carlow JJ, Shaktman BD. Symptomatic fibroid management: systematic review of the literature. JSLS 2017; 21(3): e2017.00041. google scholar
7. 7. Huang HY, Liu YC, Li YC, Kuo HH, Wang CJ. Comparison of three different hemostatic devices in laparoscopic myomectomy. J Chin Med Assoc 2018; 81(2): 178-82. google scholar
8. 8. Li YT, Chang WH, Wang PH. Laparoscopy-aided myomectomy. J Obstet Gynaecol Res 2010; 36(4): 922. google scholar

9. 9. Wen KC, Chen YJ, Sung PL, Wang PH. Comparing uterine fibroids treated by myomectomy through traditional laparotomy and 2 modified approaches: ultraminilaparotomy and laparoscopically assisted ultraminilaparotomy. Am J Obstet Gynecol 2010; 202(2): 144.e1-8. google scholar
10. 10. Shin DG, Yoo HJ, Lee YA, Kwon IS, Lee KH. Recurrence factors and reproductive outcomes of laparoscopic myomectomy and minilaparotomic myomectomy for uterine leiomyomas. Obstet Gynecol Sci 2017; 60(2): 193-9. google scholar
11. 11. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22(6): 665-86. google scholar
12. 12. Ibrahimov AM, Gaziyev AYU. Surgical and oncological outcomes in women with endometrial cancer treated via minimally invasive surgery – a single-center study in low-income country. World Med Biol 2024; 3(89): 66-70. google scholar
13. 13. Ibrahimov A. Application and clinical results of minimally invasive surgery based on pathohistological criteria in uterine cancer: A single center study in a low-income country. Actual Gyn 2024; 16: 70-4. google scholar
14. 14. Cezar C, Becker S, di Spiezio Sardo A, Herrmann A, Larbig A, Tanos V, et al. Laparoscopy or laparotomy as the way of entrance in myoma enucleation. Arch Gynecol Obstet 2017; 296(4): 709-20. google scholar
15. 15. Baekelandt J. Transvaginal natural-orifice transluminal endoscopic surgery: a new approach to myomectomy. Fertil Steril 2018; 109(1): 179. google scholar