Laparoscopic excision of very large myomas.

STUDY OBJECTIVE: To evaluate the feasibility, complications, and conversion rate of laparoscopic excision of very large myomas.

DESIGN: Prospective study (Canadian Task Force classification II-2).

SETTING: Private endoscopy center.

PATIENTS: Fifty-one women with at least one myoma larger than 9 cm.

INTERVENTION: Laparoscopic myomectomy.

MEASUREMENTS AND RESULTS: We removed 78 myomas laparoscopically in these 51 patients. Three patients had two myomas larger than 9 cm, three had two myomas between 5 and 9 cm (in addition to 1 > 9 cm), and one had three myomas between 5 and 9 cm (in addition to 1 > 9 cm). Mean number of myomas removed/patient was 1.53 +/- 1.17 (range 1-6); 12 women (23.5%) had multiple myomectomy. The largest myoma removed was 21 cm. Mean myoma weight was 698.47 +/- 569.13 g (range 210-3400 g). Mean operating time was 136.67 +/- 38.28 minutes (range 80-270 min). Mean blood loss was 322.16 +/- 328.2 ml (range 100-2000 ml). One patient developed a broad ligament hematoma, two developed postoperative fever, and one underwent open subtotal hysterectomy 9 hours after surgery for dilutional coagulopathy.

CONCLUSION: Myomectomy by laparoscopy is a safe alternative to laparotomy for very large myomas.