Background and Objectives

Laparoscopic and robotic-assisted myomectomy are limited in the number and size of myoma removed, while abdominal myomectomy is associated with increased complications and morbidity. The objective of our study was to evaluate surgical outcomes of myomectomy approaches, including laparoscopic-assisted abdominal myomectomy, a hybrid approach that combines laparoscopy and minilaparotomy with bilateral uterine artery occlusion or ligation to control blood loss.

Methods

Retrospective chart review of 1,313 consecutive laparoscopic, robotic, abdominal, and laparoscopic-assisted abdominal myomectomies performed for women > 18 years old with non-malignant indications at a suburban community hospital from January 2011 through December 2013.

Results

Review included 163 (12 percent) laparoscopic, 156 (12 percent) robotic, 686 (52 percent) abdominal, and 308 (24 percent) laparoscopic-assisted abdominal myomectomies. While the average number, size, and total weight of leiomyomas removed via laparoscopic-assisted abdominal myomectomy and abdominal approaches was comparable (9.1, 8.13 cm, 391 g and 9.0, 7.5 cm, 424 g respectively P <.0001), the number and weight of both groups was significantly larger than the laparoscopic and robotic groups (2.9, 217 g and 2.9, 269 g, respectively; P < .0001). Robotics had the highest intraoperative complication rate and the abdominal group had the highest postoperative complication rate, both at approximately three times greater than laparoscopic-assisted abdominal myomectomy. There was no difference in the intra- and postoperative complication rates between laparoscopic and laparoscopic-assisted abdominal myomectomy groups.

Conclusion

The laparoscopic-assisted abdominal myomectomy approach removed significantly greater tumor loads than laparoscopy or robotic-assisted myomectomy, yet comparable to the abdominal approach with significantly fewer complications.