Factors influencing surgical outcomes of laparoscopic myomectomy. A propensity-score matched analysis

Amedeo Catanese; Gabriele Siesto; Gaspare Cucinella; Vito Chiantera; Silvia Culmone; Antonio Schiattarella; Gloria Calagna; Domenico Vitobello

doi:10.5114/pm.2022.118970

Factors influencing surgical outcomes of laparoscopic myomectomy. A propensity-score matched analysis

Prz Menopauzalny. 2022 Sep;21(3):149-156. doi: 10.5114/pm.2022.118970. Epub 2022 Sep 1.

Authors

Amedeo Catanese¹, Gabriele Siesto², Gaspare Cucinella³, Vito Chiantera⁴, Silvia Culmone³, Antonio Schiattarella⁵, Gloria Calagna³, Domenico Vitobello²

Affiliations

¹ Obstetrics and Gynecology, "Umberto I" Hospital - ASP 8, Siracusa, Italy.
² Obstetrics and Gynecology, Humanitas Clinical and Research Center, Rozzano (MI), Italy.
³ Obstetrics and Gynecology, "Villa Sofia Cervello" Hospital, University of Palermo, Italy.
⁴ Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, University of Palermo, Italy.
⁵ Department of Woman, Child and General and Specialized Surgery University of Campania "Luigi Vanvitelli", Largo Madonna delle Grazie, Naples, Italy.

Abstract

Introduction: To evaluate factors influencing surgical choice in performing uterine myomectomy by comparing laparoscopic and open approach surgery.

Material and methods: We analyzed women undergoing uterine myomectomy in our hospital. Patients were divided into two groups: patients who underwent laparoscopic myomectomy (group A) and patients who underwent laparotomic myomectomy (group B). We matched 1 : 1 women in these two groups to compare the effects of the procedures on each outcome according to a propensity-matched score analysis.

Results: 460 myomectomies were performed in the study period: 361 cases by laparoscopy (group A) and 99 cases by laparotomy (group B). We found lower estimated intraoperative blood loss (200 ml group A vs. 300 ml group B, < 0.0001) and a smaller decrease in hemoglobin value on the first postoperative day (1.7 g/dl group A vs. 2.2 g/dl group B, < 0.0001) with the laparoscopic approach. The propensity score matching estimated that to obtain an equivalent outcome, we required an average of 2 myomas and an average diameter of 8 cm in laparoscopy and 10 cm in laparotomy. Moreover, the variables mostly associated with a laparotomic conversion were the presence of a myoma > 8 cm and association with the presence of more than 2 myomas.

Conclusions: Despite some proposals from previous studies, there are no specific guidelines regarding the best surgical procedure for myomectomy. Our data confirm that the choice of surgical technique should consider the patient characteristics and the surgeon experience to reduce longer operating times and more significant blood loss.

Keywords: LPS; gynecological surgery; laparoscopy; myomectomy; propensity score.