Laparoscopic Versus Open Myomectomy for Uterine Fibroids

Summary

A Cochrane review [Abstract] 1 included 9 studies with a total of 808 subjects. Postoperative pain was measured on a visual analogue scale (VAS, 0-10), with zero meaning 'no pain at all'. Postoperative pain was significantly less, at 6 hours (MD -2.40, 95% CI -2.88 to -1.92; one study, n=148 women, moderate-quality evidence) and 48 hours postoperatively (MD -1.90, 95% CI -2.80 to -1.00; 2 trials, n=80 women, I² = 0%, moderate-quality evidence) in the laparoscopic myomectomy group compared with the open myomectomy group. No significant difference in postoperative pain score was noted between the groups at 24 hours. In-hospital adverse events: No evidence suggested a difference in unscheduled return to theatre (OR 3.04, 95% CI 0.12 to 75.86; 2 studies, n=188, I² = 0%, low-quality evidence) and laparoconversion (OR 1.11, 95% CI 0.44 to 2.83; 8 studies, n=756, I² = 53%, moderate-quality evidence) when open myomectomy was compared with laparoscopic myomectomy. Significantly lower risk of postoperative fever was observed in the laparoscopic group compared with groups treated with all types of open myomectomy (OR 0.44, 95% CI 0.26 to 0.77; 6 studies, n=635, I² = 0%).Shorter hospital stay was found with laparoscopic compared with all types of open myomectomy. No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy (RR 1.12, 95% CI 0.63 to 1.99; 4 trials, n=460, I² = 0%).The incidence of visceral injuries could not be estimated because of their low prevalence in this meta-analysis.

A retrospective study 2 included 753 women (474 underwent laparoscopic myomectomy (LM) and 279 patients underwent open myomectomy (OM). The patients were followed-up postoperatively from 6 months to 8 years. Recurrence was confirmed when a myoma with a diameter of ≥ 1 cm was detected. The cumulative recurrence rates between the two groups were 76.2% (LM) vs. 63.4% (OM) at 8 years postoperatively. A log-rank test revealed a significant difference between the two groups. Cox hazard testing revealed that LM, a larger number of enucleated myoma masses and the absence of postoperative gestation significantly contributed to the postoperative recurrence rate.