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Background <p>Complex myomectomies involving large fibroids (&gt; 10&#xa0;cm) or multiple fibroids are considered technically challenging in laparoscopic surgery. This original study aims to compare fertility outcomes and complication rates between laparotomy and laparoscopy in the context of complex myomectomies.</p> Methods <p>This retrospective study was approved by the Ethics Committee of Brugmann University Hospital (CE2023/79). Complex myomectomies were defined as either single fibroids &gt; 10&#xa0;cm or multiple fibroids. Ninety-four patients (mean age: 35 years) were included. The laparoscopic and laparotomic groups consisted of 54 and 40 patients, respectively. Data normality was assessed using Q-Q plots. When normality could not be confirmed, comparisons were performed using Mann-Whitney tests (unpaired) or Wilcoxon tests (paired). When normality was confirmed, t-tests were used.</p> Results <p>Perioperative blood loss was significantly higher in the laparotomy group (700 vs. 500 mL, <i>p</i> = 0.031), along with a greater drop in hemoglobin levels (2.3 vs. 2.1&#xa0;g/dL, <i>p</i> = 0.081) and a higher transfusion rate (0.13% vs. 0.06%, <i>p</i> = 0.486). Median operative time was shorter (180 vs. 240&#xa0;min, <i>p</i> = 0.0002), and hospital stay was longer (3 vs. 2 days, <i>p</i> &lt; 0.0001) in the laparotomy group. The conversion rate to laparotomy was 3.2%. In multiple linear regression, blood loss was significantly associated with the number and weight of fibroids. Hospital stay was influenced by patient age, fibroid weight, and surgery duration. 32% of patients achieved pregnancy postoperatively, with no statistically significant difference between the two groups (<i>p</i> = 0.5304).</p> Conclusion <p>These findings suggest that, even in complex cases (multiple fibroids or a single fibroid &gt; 10&#xa0;cm), the laparoscopic approach can remain the first-line treatment. Laparoscopic myomectomy is not associated with increased risk or complications and is linked to significantly reduced blood loss and shorter hospitalisation, without compromising fertility outcomes.</p>

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Laparoscopy versus laparotomy in complex and multiple myomectomies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月1日

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  • Panayiotis Tanos,
  • Robin Hupet,
  • Ambre Balestra,
  • Evy Gillet,
  • Deliar Yazdanian,
  • Elie Finianos,
  • Sara Engels,
  • Francesca Donders,
  • Georges Salem Wehbe,
  • Michelle Nisolle,
  • Stavros Karampelas

摘要

Background

Complex myomectomies involving large fibroids (> 10 cm) or multiple fibroids are considered technically challenging in laparoscopic surgery. This original study aims to compare fertility outcomes and complication rates between laparotomy and laparoscopy in the context of complex myomectomies.

Methods

This retrospective study was approved by the Ethics Committee of Brugmann University Hospital (CE2023/79). Complex myomectomies were defined as either single fibroids > 10 cm or multiple fibroids. Ninety-four patients (mean age: 35 years) were included. The laparoscopic and laparotomic groups consisted of 54 and 40 patients, respectively. Data normality was assessed using Q-Q plots. When normality could not be confirmed, comparisons were performed using Mann-Whitney tests (unpaired) or Wilcoxon tests (paired). When normality was confirmed, t-tests were used.

Results

Perioperative blood loss was significantly higher in the laparotomy group (700 vs. 500 mL, p = 0.031), along with a greater drop in hemoglobin levels (2.3 vs. 2.1 g/dL, p = 0.081) and a higher transfusion rate (0.13% vs. 0.06%, p = 0.486). Median operative time was shorter (180 vs. 240 min, p = 0.0002), and hospital stay was longer (3 vs. 2 days, p < 0.0001) in the laparotomy group. The conversion rate to laparotomy was 3.2%. In multiple linear regression, blood loss was significantly associated with the number and weight of fibroids. Hospital stay was influenced by patient age, fibroid weight, and surgery duration. 32% of patients achieved pregnancy postoperatively, with no statistically significant difference between the two groups (p = 0.5304).

Conclusion

These findings suggest that, even in complex cases (multiple fibroids or a single fibroid > 10 cm), the laparoscopic approach can remain the first-line treatment. Laparoscopic myomectomy is not associated with increased risk or complications and is linked to significantly reduced blood loss and shorter hospitalisation, without compromising fertility outcomes.