Evaluation of indications for laparoscpic myomectomy using the sum of maximum myoma diameters

Recently, an increasing number of women with multiple uterine myomas have opted for laparoscopic myomectomy, and with this increase, the need to define the indications and limitations of this approach has become apparent. The purpose of this study was to investigate these factors. A total of 130 patients undergoing laparoscopic myomectomy per standard indications between January, 2005 and December, 2010 were studied. Those with complications such as endometriosis and adnexal disease were excluded. The sum of the maximum myoma diameters (SMD), reflecting both size and count, served as a new unit of measurement. Operative blood loss correlated at a statistically significant level with maximum diameter and number of enucleated myomas (r= 0.286, p= 0.001 and r= 0.194 p= 0.028, respectively), as did with operating time (r= 0.277, p= 0.001 and r= 0.405, p< 0.001). With respect to SMD and operative blood loss or operating time, the positive correlations were even more significant (r= 0.380, p< 0.001 and r= 0.562, p<0.001, respectively). In cases exceeding the 90th percentile of operative blood loss and operating time, the average of SMD was 183.3mm. When the average of SMD was more than 183.3mm, odds ratios (OR) for the relationship between SMD and excessive bleeding (>90th percentile) and excessive operating time (>90th percentile) were 6.06 (95%CI;1.58-23.18, P=0.013) and 7.14 (95%CI;2.31-22.08, P=0.001), respectively. Thus, SMD was considered an appropriate determinant for laparoscopic myomectomy in borderline cases. Evaluation of eligibility criteria is equally important as equipment and technique advancements in improving the patient safety and outcomes in this setting.