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CC BY 4.0 · Surg J (N Y) 2021; 07(01): e47-e53
DOI: 10.1055/s-0040-1722657
Original Article

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

Andrea Tinelli 
1   Department of Obstetrics and Gynecology, “Veris delli Ponti” Hospital, Scorrano, Lecce, Italy
,
Ioannis P. Kosmas 
2   Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Hatzikosta, University of Ioannina, Ioannina, Greece
,
William H. Catherino
3   Department of Obstetrics and Gynecology, Uniformed Services, University of the Health Sciences, Bethesda, Maryland
,
Jose Carugno 
4   Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Science, University of Miami, Miller School of Medicine, Miami, Florida
,
Ospan A. Mynbaev 
5   Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia
,
Radmila Sparic 
6   Clinic for Gynecology and Obstetrics, Clinical Centre of Serbia, School of Medicine, University of Belgrade, Serbia
,
Giuseppe Trojano 
7   Department of Obstetrics & Gynecology, Madonna delle Grazie Hospital, Matera, Italy
,
Antonio Malvasi 
8   Department of Obstetrics & Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy
› Author Affiliations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
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Abstract

Authors evaluated the impact of laparoscopic intracapsular myomectomy (LIM) in women 40 years of age and over with desire of future fertility compared with medical management of symptomatic fibroids, by a prospective cohort study in University affiliated Hospitals. This study includes a cohort of women 40 years of age and older with symptomatic intramural fibroids with desire of future fertility. Women with symptomatic fibroid uterus were offered to undergo LIM or medical management. They were encouraged to attempt conception either spontaneously or by assisted reproductive technology (ART) according to their individual preference. All women were followed for 2 years. Fibroid characteristics, pre- and post-surgical variables, including surgical complications, days of hospitalization, pregnancy rate, and obstetrical outcomes were collected. A total of 100 patient were included in the analysis. Fifty patients were assigned to the LIM group and 50 to the medical treatment group (MT). Groups were similar regarding age (43.5 ± 2.4 and 43.5 ± 2.4, p = 0.99), body mass index (23.8 ± 3.1 and 24.2 ± 3.1, p = 0.54), parity (0.46 ± 0.09 and 0.58 ± 0.09, p = 0.37), fibroid number (1.38 ± 0.6 and 1.46 ± 0.6, p = 0.53), and fibroid size (5.92 ± 1.62 cm vs. 5.94 ± 1.49 cm, p = 0.949). Of the patients who underwent LIM, 62% conceived within the study period compared with 56% in the control group (p = 0.54). Pregnancy was achieved by ART in 44% of the patients of the LIM group and 30% in control group. There was no significant difference in pregnancy rates among the two groups regarding spontaneous pregnancy rate (p = 0.332), nor in pregnancies obtained by ART with own eggs (p = 0.146) and oocyte or embryo donation (p = 0.821). The take home baby rate was 65% (20/31) in the LIM group and 61% (17/28) in the control group (p = 0.7851). Both groups had similar rate of miscarriage (p = 0.748).

Patients 40 years old and over with symptomatic fibroid uterus who undergo LIM have similar subsequent fertility and obstetrical outcomes than women treated with medical management. LIM has no detrimental impact on future fertility in women 40 years old and over.

Keywords

laparoscopic myomectomy - myoma pseudocapsule - reproductive outcome - menopause - pregnancy - uterine ageing

Authors' Contribution

A.T., I.K., and A.M. conceived and were responsible for carrying out the study; A.T., R.S., and G.T. performed data collection, management, and analysis; I.K. was responsible for the statistical evaluation; A.T. and R.S. wrote the final manuscript and W.C., J.T.C., and O.A.M. critically revised the manuscript; A.T. and A.M. recruited patients. All of the authors reviewed, edited, and approved the final submission.


Details of Ethics Approval

Ethical committee approval (code of authorization T7WGSJ3) and signed informed consent for surgery and post-surgical follow-up were acquired before the study. The laparoscopic approach is the standard surgical procedure for myomectomy at our Institutions, and the group II patients chose a long-term clinical follow-up and pharmacological treatment.




Publication History

Received: 28 May 2020

Accepted: 23 November 2020

Article published online:
22 March 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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