Uterine myometrial thickness at the site of myomectomy scar after laparoscopic myomectomy compared to conventional open myomectomy

Abstract

Myomas are the most common benign uterine tumors that are seen in 20-25% of women of reproductive age. The limitation of laparoscopy is related to the size of the myoma, if the myoma is larger than 15 cm, or if there are many myomas, or if the fundus of the uterus is touched above the navel during the examination, or if the association of myoma with uterine cavity cannot be identified in the MRI, it is better not to use the laparoscopic method. The purpose of the current study is to investigate the effect of laparoscopic and laparotomy surgery on the thickness and vascularity of the uterine myometrium in the myomectomy scar site (comparison of the sonographic features of the myomectomy scar site, including the thickness, vascularity and amount of fibrosis in surgical scar site in both open and laparoscopic surgery methods). Materials and Methods: In this clinical trial study, 100 women who had type 2-5 uterine myomas and with various clinical symptoms referred to Al-Zahra Hospital in Tabriz for surgery and who met the conditions for entering the study were selected. The maximum size of myoma in single myoma cases was 8 cm, and in multiple myoma cases, the maximum number of three myomas, the largest of which was 5 cm, was investigated. The investigated myomas were in FIGO grading group 2-5. All surgeries were performed by one doctor. Six months after surgery, sonographic features of the myomectomy scar including thickness, vascularity and the amount of fibrotic tissue in the surgical scar were compared in two laparoscopy and laparotomy groups. The objectives of the study include comparing the thickness and vascularity of the myometrium at the myomectomy scar site, the duration of hospitalization, comparing the amount of bleeding during the operation, comparing the duration of the operation, comparing the time required to obtain the appropriate vascularity (similar to other parts of the myometrium) and obtaining the minimum thickness of the myometrium. 2 mm in myomectomy scar site and comparison of the number of cases of endometrial opening during myomectomy with two laparoscopic and laparotomy methods. Results: The patients of the two groups did not differ in terms of age, obstetric characteristics, and history of infertility and were similar. The average age of the patients was 38.66 ± 4.65 years. The average length of hospitalization in laparoscopic and laparotomy myectomy, the average length of hospitalization in the groups was 1.64 ± 0.56 days and 1.89 ± 0.58 days respectively, and a statistically significant difference was observed between the two groups (p=0.028). Also, comparing the amount of intraoperative bleeding in laparoscopic myectomy and laparotomy, the average amount of hemoglobin drop was 1.92 ± 0.89 units and 2.24 ± 0.87 units, respectively. There was a statistically significant difference between the two groups (p=0.003). Significantly, there were more multiple myomas in the laparotomy group patients (38 vs. 28%; p=0.031) and there were more single myomas in the laparoscopy group (82 vs. 62%; p=0.031). The size of myomas in the laparotomy group was significantly higher than the laparoscopy group. In terms of FIGO classification, in the laparotomy group, class 2-5 was observed in 44% and class 5 in 40% of patients; And in the laparoscopic group, most of the patients (56%) were in the 2-5th class. Meanwhile, in the present study, the duration of the operation in the laparotomy group was significantly less than the laparoscopy group (p=0.001). The most common clinical symptoms in patients were related to AUB (78%). There was no case of pressure in the abdomen in the laparoscopy group, but this clinical symptom was observed in 12% of the patients in the laparotomy group (p=0.013).