Organ-preserving laparoscopic myomectomy in atypical leiomyoma arrangement

BACKGROUND: Uterine fibroids are the most common cause of surgical treatment in women and total hysterectomy is performed in most cases to radically solve this problem. The organ-preserving approach aims to preserve fertility and the ability to reproduce in patients of reproductive age. The atypical location of leiomyomas complicates the possibility of performing an organ-preserving myomectomy.

AIM: The aim of this study was to assess the possibility of performing myomectomy for atypical leiomyoma using laparoscopic access in routine practice to preserve fertility and implement reproductive plans.

MATERIALS AND METHODS: This study included 213 patients of reproductive age with uterine fibroids. Myomectomy for typical or atypical leiomyomas was performed by laparoscopic access. A comparative analysis of surgical treatment and perioperative management of patients with atypically located fibroids and fibroids of other localization was carried out. The results of the achievement by the patients of their reproductive goals were evaluated. The duration of follow-up was 24 months.

RESULTS: Atypical node location was noted in 65 (30.5%) cases. When comparing the duration of surgical treatment, volume of blood loss, need for analgesics, presence of intraoperative and postoperative complications, duration of hospitalization and recovery period in patients with atypical leiomyoma, these parameters did not differ from those in the surgical treatment of patients with typical leiomyoma. Anatomical and functional results of surgical treatment were analyzed after one, three, six, 12, and 24 months. Of the 70 patients planning pregnancy, 26 (37%) women became pregnant on average 8.3 months after surgery. The location of the removed fibroids was atypical in ten cases.

CONCLUSIONS: The atypical location of leiomyoma does not affect the course of the surgical and postoperative periods and long-term results of surgical treatment. The possibility of routine organ-preserving treatment by laparoscopic access in patients with atypical fibroids leaves prospects for the implementation of the woman’s reproductive plans.