PATIENT SELECTION FOR LAPAROSCOPIC MYOMECTOMY

Study Objective. To determine if preoperative criteria could select patients who were likely to be managed successfully by laparoscopic myomectomy. Design. Prospective. Setting. Two community hospitals. Patients. Premenopausal women who had symptomatic uterine myomata and met the following criteria underwent laparoscopic myomectomy: uterine size less than or equal to 14 weeks after 12 weeks of gonadotropin-releasing hormone (GnRH) agonist therapy; no individual myoma larger than 7 cm; no leiomyoma near the uterine artery, or near the tubal cornua if fertility was desired; and at least 50% of the leiomyoma subserosal, to be accessible and to allow adequate repair of the myometrium through the laparoscope. Interventions. Laparoscopic assessment of the pelvis and laparoscopic myomectomy. Measurements and Main Results. Forty-one patients entered the study: 23 met the selection criteria and were accepted for laparoscopic myomectomy, but 4 were excluded during laparoscopic assessment of the pelvis. Clinical examination or initial sonogram correctly predicted successful laparoscopic myomectomy in 13 of the 19 women. After 3 months of GnRH agonist therapy, clinical examination or sonogram identified four additional candidates. In six patients in whom the optimum approach was Still uncertain, laparoscopic assessment found two additional appropriate candidates for laparoscopic myomectomy. Nineteen patients underwent the procedure without the need to convert to laparotomy. None experienced any complications. Conclusions. Careful patient selection can decrease the likelihood of inappropriate performance of laparoscopic myomectomy and avoid the need to convert to laparotomy.