A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes

Palomba, Stefano; Zupi, Errico; Falbo, Angela; Russo, Tiziana; Marconi, Daniela; Tolino, Achille; Manguso, Francesco; Mattei, Alberto; Zullo, Fulvio

doi:10.1016/j.fertnstert.2006.12.047

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Volume 88, Issue 4 , Pages 933-941, October 2007

A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes

Stefano Palomba, M.D.
- Department of Obstetrics & Gynecology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
- Reprint requests: Stefano Palomba, M.D., Via Mario Greco 10, vico XI, 88100 Catanzaro, Italy (FAX: 39-961-728329).
Errico Zupi, M.D.
- Department of Obstetrics & Gynecology, University “Tor Vergata” of Rome, Rome, Italy
Angela Falbo, M.D.
- Department of Obstetrics & Gynecology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
Tiziana Russo, M.D.
- Department of Obstetrics & Gynecology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
Daniela Marconi, M.D.
- Department of Obstetrics & Gynecology, University “Tor Vergata” of Rome, Rome, Italy
Achille Tolino, M.D.
- Department of Obstetrics & Gynecology, University “Federico II” of Naples, Naples, Italy
Francesco Manguso, M.D.
- Department of Clinical and Experimental Medicine, University “Federico II” of Naples, Naples, Italy
Alberto Mattei, M.D.
- Department of Obstetrics & Gynecology, University of Florence, Florence, Italy
Fulvio Zullo, M.D.
- Department of Obstetrics & Gynecology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy

Received 3 July 2006; received in revised form 20 December 2006; accepted 27 December 2006. published online 16 April 2007.

Objective

To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive.

Design

Randomized controlled trial.

Setting

Departments of obstetrics and gynecology of the universities of Catanzaro, Rome, and Florence, Italy.

Patient(s)

One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility.

Intervention(s)

Laparoscopic and minilaparotomic myomectomy.

Main Outcome Measure(s)

Pregnancy, abortion, and live-birth rates.

Result(s)

Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy, live-birth, and abortion rates, whereas pregnancy and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group. Categorizing the patients according to surgical indication for myomectomy, cumulative pregnancy rate, pregnancy, and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients, whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility.

Conclusion(s)

Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility, whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas.

Key Words: Fertility, fibroid, infertility, laparoscopy, leiomyomas, minilaparotomy