Difficulties and complications of laparoscopic myomectomy

The goal of this study was to assess the difficulties and the risks of complications with laparoscopic myomectomy. Based on a series of 213 patients who underwent 437 myomectomies, the rate of failure (by which we mean conversions to laparotomy) was 7.5% (16 patients), and the rate of complications was 3.8% (8 patients). Conversions to laparotomy were indicated in over half of these cases (9 cases, 56.25%) because of difficulties in making a satisfactory uterine suture and in, one third of the cases, because of perioperative hemorrhage problems. The risk of conversion to laparotomy is statistically correlated to the size of the myomas (p = 0.0001) and is three times higher for anterior myomas than for fibroids located at the fundus or the posterior wall. Of the 34 patients who had an intrauterine pregnancy after laparoscopic myomectomy, we observed only 1 case of uterine rupture. Laparoscopic myomectomy is a reliable technique that should only be proposed, however, when the fibroid size is less than 8 cm and when there are not more than two fibroids to be removed.