My interpretation of the study suggests that laparoscopy and mini-laparotomy result is similar outcomes. The length of surgery and pregnancy rates were the same.
The hospital stay was about 1 day longer with mini-laparotomy (statistically significant) but likely not terribly important to patients. Thus, I suggest that laparoscopy has minimal benefits over a mini-laparotomy and surgeon comfort with the technique will dictate the best approach. A shorter hospital stay is certainly nice and cost saving.
Mario Malzoni, M.D.a, Raffaele Tinelli, M.D.aCorresponding Author Informationemail address, Francesco Cosentino, M.D.a, Domenico Iuzzolino, M.D.aemail address, Daniela Surico, M.D.b, Harry Reich, M.D.c
Received 5 September 2008; received in revised form 18 December 2008; accepted 19 December 2008. published online 16 March 2009.
Objective: To retrospectively compare the feasibility, safety, morbidity, and pregnancy outcome of laparoscopy (LPS) and minilaparotomy (LPT) in the treatment of symptomatic uterine myomas.
Design: Retrospective, nonrandomized study.
Setting: Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy.
Patient(s): 680 nonconsecutive patients with symptomatic uterine myomas.
Intervention(s): 350 women underwent LPS, and 330 underwent LPT myomectomy.
Main Outcome Measure(s): Operative time, blood loss, hospital stay, pregnancy rate, and spontaneous abortion rate.
Result(s): The mean operative time was 63 ± 21 minutes (95% CI, 48–143) in the LPS group and 57 ± 23 minutes (95% CI, 38–121) in the LPT group. The mean length of hospital stay was statistically significantly greater in the LPT group (3.1 ± 0.5; 95% CI, 1–5) than the LPS group (2.1 ± 0.8; 95% CI, 1–4). The overall spontaneous pregnancy rate after myomectomy was 53%; the pregnancy rate after LPS myomectomy (56%) was not statistically significantly higher than the rate for LPT (50%).
Conclusion(s): Laparoscopy showed a lower morbidity than reported for the open approach and was characterized by less blood loss and a shorter postoperative hospitalization with an higher pregnancy rate. The operating time was not much longer in the laparoscopic group, and the intraoperative and postoperative complications appeared acceptable and not more than what is traditionally expected with the open approach.
Volume 93, Issue 7, Pages 2368-2373 (1 May 2010)
a Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy
b Department of Obstetrics and Gynecology, University Medical School of Novara, Novara, Italy
c Wilkes Barre General Hospital, Wilkes Barre, Pennsylvania