Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study

BACKGROUND: To compare in the first 7 days after surgery the outcome of myomectomy performed by three laparotomic approaches: laparotomy (LT), minilaparotomy (MLT) and laparoscopically assisted minilaparotomy (LA‐MLT). METHODS: Fifty‐one women with 5–15 cm total myoma diameter were randomized blindly using a computer randomization list, to LT (n = 17), MLT (n = 17) or LA‐MLT (n = 17). RESULTS: Mean operation length was similar in the three groups. Mean (± SEM) time of paralytic ileus (55.0 ± 4.5 versus 33.4 ± 3.4 h; P < 0.01) and discharge (141.6 ± 5.2 versus 81.5 ± 8.2 h; P < 0.01) was longer in LT than LA‐MLT or even MLT. In comparison with LA‐MLT, LT induced a greater haemoglobin decline (–3.07 ± 0.3 versus –1.8 ± 0.15 mg/dl; P < 0.025), and a greater post‐operative stress, as documented by increased prolactin (+15.1 ± 3.8 versus +0.16 ± 4.5 ng/ml; P < 0.03) and decreased insulin sensitivity (fasting glucose/insulin; –7.5 ± 2.6 versus –0.7 ± 2.1; P < 0.02). Seven days after surgery, abdominal pain (P < 0.05) was higher after LT (3.0 ± 0.6) than MLT (0.5 ± 0.2) and LA‐MLT (0.9 ± 0.4). CONCLUSIONS: In selected cases, myomectomy by LA‐MLT offers some advantages versus LT and, to a smaller extent, MLT.