Comparison of Laparoscopic Myomectomy and Abdominal Myomectomy Cases Performed in Our Clinic in the Last 10 Years

Yıl 2023, Cilt: 20 Sayı: 2, 403 - 407, 31.08.2023

Yusuf Ziya Kızıldemir , Neşe Gül Hilali

https://doi.org/10.35440/hutfd.1291891

Öz

Background: The aim of our study is to compare laparoscopic and abdominal myomectomies performed in our clinic and to evaluate the feasibility and safety of laparoscopic myomectomies.
Materials and Methods: In this study, we retrospectively evaluated 314 cases who were threated with myo-mectomy operation in our clinic between 2012-2022. All of the cases were divided into two groups with res-pect to the surgical procedure performed. 314 patients were in the abdominal myomectomy group, 47 patients were in the laparoscopic myomectomy group and the groups were compared.
Results: There was no statistically significant difference between the groups in terms of demographic data (p>0.05). When the groups were evaluated in terms of postoperative white blood cell(WBC), hemoglobin, hematocrit, platelet values, operation time, hospitalisation time, postoperative blood transfusion and periopera-tive complications, no statistically significant difference was observed (p>0.05). There were no statistically significant difference in terms of preoperative WBC and CRP values between the groups, but postoperative WBC and CRP values were lower in the laparoscopic myomectomy group(p<0.05).
Conclusions: Laparoscopic myomectomy has a short recovery time and aesthetic advantage. However, equip-ment and the need of experienced surgeons limit its applicability. With the development of laparoscopic tech-nologies and increasing the experience of surgeons with laparoscopic surgery, it will provide a serious ad-vantage over the abdominal method in terms of less blood loss, less hospital stay, shorter operation times, less trauma and better cosmetic results.

Kliniğimizdeki Son 10 Yıllık Laparoskopik Myomektomi ve Abdominal Myomektomi Olgularının Karşılaştırılması

Öz

Amaç: Çalışmamızın amacı kliniğimizde yapılan laparoskopik ve abdominal myomektomilerin karşılaştırılması ve elde edilen veriler ışığında laparoskopik myomektomi işleminin uygulanabilirlik ve güvenilirliğinin değerlendirilmesidir.
Materyal ve Metod: 2012-2022 yılları arasında kliniğimizde uterin myom nedeni ile cerrahi tedavi uygulanan toplam 361 hastanın dosyası retrospektif olarak incelendi. Hastalar uygulanan cerrahi yönteme göre 2 gruba ayrıldı. Abdominal myomektomi yapılmış olan 314 hasta, laparoskopik myomektomi uygulanan 47 hasta ile karşılaştırıldı.
Bulgular: Gruplar arasında demografik veriler açısından istatistiksel olarak anlamlı farklılık yoktu(p>0.05). Gruplar, postoperatif beyaz küre, hemoglobin, hematokrit, platelet değerleri, operasyon süresi, hastanede yatış süresi, postoperatif kan transfüzyonu ve perioperatif komplikasyonlar açısından değerlendirildiğinde de istatistiksel olarak anlamlı fark izlenmedi(p>0.05). Gruplar arasında preoperatif beyaz küre ve C-Reaktif Protein(CRP) değerleri arasında istatistiksel olarak anlamlı fark gözlenmedi ancak laparoskopik myomektomi grubunda postoperatif beyaz küre ve CRP değerleri daha düşük izlendi(p<0.05).
Sonuç: Laparoskopik myomektomide iyileşme süresi kısalığı ve estetik avantaj mevcuttur. Ancak, ekipman ve tecrübeli cerrah gereksinimi uygulanabilirliğini sınırlamaktadır. Laparoskopik teknolojilerin gelişmesi ve cerrahların laparoskopi tecrübelerinin artmasıyla daha az kan kaybı, daha az hastanede kalış süresi, daha kısa operasyon süreleri, daha az travma ve daha iyi kozmetik sonuçlar açısından abdominal yönteme göre ciddi avantaj sağlayacaktır ve tercih edilecektir.

Anahtar Kelimeler

laparoskopi, laparotomi, myomektomi, komplikasyon

Kaynakça

• 1. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol 2004;104:393–406.
• 2. Babaknia A, Rock JA, Jones HW. Pregnancy success fol-lowing abdominal myomectomy for infertility. Fertil Steril 1978;30:644–649
• 3. Shozu M, Murakami K, Inoue M. Aromatase and leiomyoma of the uterus. Semin Reprod Med 2004;22:51–60
• 4. Hartmann KE, Fonnesbeck C, Surawicz T, et al. Management of Uterine Fibroids. AHRQ Comparative Effectiveness Re-view. Rockville, MD: 2017. https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/cer-195-uterine-fibroids-final-revision.
• 5. Steinauer J, Pritts EA, Jackson R, Jacoby AF. Systematic review of mifepristone for the treatment of the uterine lei-omyomata. Obstet Gynecol 2004;103:1331–1336
• 6. Lethaby A, Vollenhoven B, Sowter M. Efficacy of pre-operative gonadotrophin hormone releasing analogues for women with uterine Wbroids undergoing hysterectomy or myomectomy: a systematic review. BJOG 2002;109:1077–1080
• 7. Friedman AJ, Daly M, Juneau-Norcross M, Fine C, Rein MS. Recurrence of myomas after myomectomy in women pret-reated with leuprolide acetate depot or placebo. Fertil Steril 1992;58:205–208
• 8. Hehenkamp WJ, Volkers NA, Donderwinkel PF et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine Wbroids (EMMY trial): peri and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol 2005;193:1618–1629
• 9. Chen J, Li Y, Wang Z, et al. Evaluation of high-intensity focu-sed ultrasound ablation for uterine fibroids: an IDEAL pros-pective exploration study. BJOG 2018; 125:354.
• 10. Spies JB, Spector A, Roth AR, Baker CM, Mauro L, MurphySkrynarz K. Complications after uterine artery em-bolization for leiomyomas. Obstet Gynecol 2002;100:873–880
• 11. Wamsteker K, Emanuel MH, de Kruif JH. Transcervical hys-teroscopic resection of submucous fibroids for abnormal uterine bleeding: results regarding the degree of intramural extension. Obstet Gynecol 1993; 82:736.
• 12. Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N. Ran-domized study of laparoscopy versus minilaparotomic myo-mectomy for uterine myomas. J Minim Invasive Gynecol 2006;13:92–97.
• 13. Vilos GA, Allaire C, Laberge PY, et al. The management of uterine leiomyomas. J Obstet Gynaecol Can 2015; 37:157.
• 14. Prapas Y, Kalogiannidis I, Prapas N. Laparoscopy vs. laparos-copically assisted myomectomy in the management of ute-rine myomas: a prospective study. Am J Obstet Gynecol 2009;200:144–146.
• 15. Luciano AA. Myomectomy. Clin Obstet Gynecol. 2009;52:362–371.
• 16. Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospecti-ve, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;174: 654–658.
• 17. Kalogiannidis I, Prapas N, Xiromeritis P, Prapas Y. Laparosco-pically assisted myomectomy versus abdominal myomec-tomy in short-term outcomes: a prospective study. Arch Gynecol Obstet. 2010;281: 865–870.
• 18. Mattei A, Cioni R, Bargelli G, Scarselli G. Techniques of lapa-roscopic myomectomy. Reprod Biomed Online. 2011;23:34–39.
• 19. Seracchioli R, Rossi S, Govoni F, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000;15: 2663–2668.
• 20. Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, Chen FD, Gu HZ. Laparoscopic versus open myomectomy--a meta-analysis of randomized controlled trials. Eur J Obstet Gyne-col Reprod Biol. 2009 Jul;145(1):14-21.
• 21. Dubuisso JB, Fauconnier A, Babaki-Fard K, Chapron C. Lapa-roscopic myomectomy: a current view. Hum Reprod Upda-te. 2000 Nov-Dec;6(6):588-94.
• 22. Frishman GN, Jurema MW. Myomas and myomectomy. J Minim Invasive Gynecol. 2005 Sep-Oct;12(5):443-56.
• 23. Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C. Mini-mally invasive surgical techniques versus open myomec-tomy for uterine fibroids. Cochrane Database Syst Rev. 2014 Oct 21;(10):CD004638.
• 24. Advincula AP, Xu X, Goudeau S 4th, Ransom SB. Robot-assisted laparoscopic myomectomy versus abdominal myo-mectomy: a comparison of short-term surgical outcomes and immediate costs. J Minim Invasive Gynecol. 2007 Nov-Dec;14(6):698-705.
• 25. Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, Panunzi S, Spagnolo R, Imperato F, Landi S, Fiaccamento A, Stola E. Italian multicenter study on complications of lapa-roscopic myomectomy. J Minim Invasive Gynecol. 2007 Jul-Aug;14(4):453-62.
• 26. Yao CA, Lin CH. Treatment with the herbal formulation Eefo-oton slows the progression of chronic kidney disease: A case report. Medicine (Baltimore). 2019 Oct;98(43):e17573.
• 27. Holub Z, Jabor A, Kliment L, Sprongl L. Inflammatory respon-ses after laparoscopic uterine myomectomy compared to open surgery in current clinical practice. Saudi Med J. 2006 Nov;27(11):1693-7.
• 28. Wang R, Wu W, Xu FX, Li J, Gao HP. The effect of laparosco-pic myomectomy and open surgery on the endocrine status, immune function and prognosis of patients with uterine fib-roids. Adv Mod Biomed. 2020;20:3160–3163.
• 29. Chen R, Su Z, Yang L, Xin L, Yuan X, Wang Y. The effects and costs of laparoscopic versus abdominal myomectomy in pa-tients with uterine fibroids: a systematic review and meta-analysis. BMC Surg. 2020 Mar 20;20(1):55.
• 30. Darai E, Deval B, Darles C, Benifla JL, Guglielmina JN, Made-lenat P. Myomectomie: coelioscopie ou laparotomie? [Myomectomy: laparoscopy or laparotomy]. Contracept Fer-til Sex. 1996 Oct;24(10):751-6.
• 31. Sinha R, Hegde A, Warty N, Patil N. Laparoscopic excision of very large myomas. J Am Assoc Gynecol Laparosc. 2003;10(4):461-8.