Analysis of the effectiveness of laparoscopic myomectomy using a standardized technique

BACKGROUND: Uterine fibroids are a benign monoclonal tumor arising from myometrial smooth muscle cells and fibroblasts with the deposition of extracellular matrix components in response to vascular injury. Diagnosis of uterine fibroids is steadily growing every year due to the introduction of new and accessible research methods. At the moment, the preferred organ-preserving surgical method for treating uterine fibroids is laparoscopic myomectomy, which allows preserving reproductive function. Considering the high risk of intra- and postoperative bleeding during surgery, the development and use of blood-saving technologies remains relevant. This article contains results of the effectiveness of the surgical technique without performing the stage of vessel clipping, which involves assessing the volume of intraoperative blood loss and the duration of the operation. AIM: The aim of this study was to analyze the effectiveness of using a standardized technique of laparoscopic myomectomy without uterine artery clipping. MATERIALS AND METHODS: This study included 77 patients with symptomatic uterine fibroids who underwent surgical treatment in Gynecological Department I with Operating Unit, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (St. Petersburg, Russia). Implying an assessment of the volume of intraoperative blood loss and the duration of the operation. RESULTS: The average number of removed myomatous nodes was 2.2 ± 1.2 (from 1 to 11). The size of the removed fibroids averaged 5.1 ± 1.8 cm in diameter. At the same time, the minimum size of the remote node was 1.5 cm, and the maximum size was 15 cm. Intramural [International Federation of Gynecology and Obstetrics (FIGO) types 3 and 4] localization of myomatous nodes was found in 30 (17.6%) cases, intramural subserosal (FIGO type 5) in 45 (26.4%) cases, subserosal (FIGO type 6) in 54 (31.7%) cases, subserosal pedunculated (FIGO type 7) in 30 (17.6%) cases, and intramural submucosal and submucosal forms (FIGO types 0–2) in ten (5.8 %) cases. The average intraoperative blood loss was 187.7 ± 16.71 ml, average hemoglobin level in the postoperative period was 117.1 ± 13.15 g/l, with an initial level of 126 ± 12.1 g/l. The average duration of the operation was 95 ± 30.3 minutes, and the average bed-day was 8 ± 1.5. CONCLUSIONS: The data obtained allow for drawing a reasonable conclusion about the effectiveness and safety of the standardized technique of laparoscopic myomectomy, developed in Gynecological Department I with Operating Unit, The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (Saint Petersburg, Russia), and for recommending its widespread use.