Page 23 - World Journal of Laparoscopic Surgery

WJOLS

Minimally Invasive Surgical Techniques vs Open Myomectomy for Treatment of Uterine Fibroids
RESUlTS and two articles were prospective nonrandomized
trials.
Ten articles were selected for this review. Among • 4 out of 10 studies reported postoperative pain (within
these six were randomized control trials, and one the first 7 days) (Table 1). 1,2,6-10
of the six was double-blind. One was a retrospective • 6 out of 10 studies reported in-hospital adverse
matched control analysis, one was a systematic review, events. 1,5,6,7,9,10

Table 1: Summary of outcomes of various studies comparing laparoscopic vs open myomectomy
Author and year of Type of study;
publication sample size Outcomes studied Laparoscopy Laparotomy p-value
Chittawar et al Systematic review; • Postoperative pain MD –2.40
(2014) 1 808 • In-hospital adverse events OR 0.44
• Hospital stay
Tinelli et al (2014) 2 Prospective study; • Operating time 95 ± 7.2 min 63 ± 5.6 < 0.0001
124 • Intraoperative blood loss 65 mL 105 ± 5 mL < 0.0001
• Postsurgical blood loss 30 ± 5 mL 60 ± 5 mL < 0.0001
• Postsurgical pain relief requirement 8 patients 17 patents < 0.05
Malzoni et al Retrospective, • Operative time 63 ± 21 min 57 ± 23 min 95% CI
(2010) 3 nonrandomized • Hospital stay 2.1 ± 0.8 3.1 ± 0.5 95% CI
study; 680 • Pregnancy rate 56% 50% NS
Kalogiannidis Nonrandomized • Blood loss 246 ± 161 mL 351 ± 219 mL = 0.03
et al (2010) 4 prospective study; • Operative time 68 ± 21 min 83 ± 24 min = 0.01
75 • Days of bowel reactivity 1.04 ± 0.2 1.8 ± 0.5 < 0.0001
• Duration of hospitalization 1.2 ± 0.6 4.2 ± 0.8 < 0.0001
Cicinelli et al Prospective • Mean blood loss Conversion to < 0.001
(2009) 5 randomized study; • Mean duration of postoperative ileus laparotomy in < 0.001
80 • Mean decrease in hemoglobin one patient < 0.001
• Mean operative time NS
• Duration of hospitalization < 0.001
• Intraoperative complications
Tan et al Randomized • Mean operating time 96 ± 26.20 min 75.50 ± 25.70 = 0.006
(2008) 6 trial; 52 • Intraoperative blood loss 96.34 ± 32.42 mL 71.92 ± 18.98 mL = 0.002
• Hemoglobin level decrease 1.65 ± 0.61 1.22 ± 0.61 = 0.014
• Hospitalization days 1.81 ± 0.57 days 2.04 ± 0.66 days = 0.183
• Postoperative ileus 23.20 ± 4.37 22.80 ± 3.94 = 0.738
Sesti et al Randomized • Mean discharge time 98.4 ± 1.4 hr 52.8 ± 1.6 hr < 0.001
(2008) 7 trial; 100 • Operation time 79.5 ± 25.1 min 103.5 ± 24.9 min < 0.001
• Intraoperative blood loss 154.2 ± 1.2 mL 188.6 ± 1.3 mL < 0.001
Palomba et al Randomized • Pregnancy rate per cycle 36/556 (6.5) 26/669 (3.9) 0.040
(2007) 8 controlled • Cumulative pregnancy rate 36/68 (52.9) 26/68 (38.2) 0.090
trial; 136 • Live-birth rate per cycle 32/556 (5.8) 22/669 (3.1) 0.036
• Cumulative live-birth rate 32/36 (88.9) 22/26 (84.6) 0.620
• Time to first pregnancy (month) 5 (3), 1–9 6 (2.5), 4–11 0.008
• Time to first live-birth (month) 14 (3), 10–18 15 (3), 13–20 0.003
• Abortion rate 4/32 (12.5) 4/26 (15.4) 0.751
• Preterm delivery 1/32 (3.1) 1/22 (4.5) 0.786
• Vaginal delivery 9/32 (28.1) 8/22 (36.4) 0.522
• Cesarean delivery 23/32 (71.9) 14/22 (63.6) 0.522
Holzer et al Prospective, • VAS pain 2.28 ± 1.38 4.03 ± 1.63 < 0.01
(2006) 9 double-blind; 40
Alessandri et al Randomized • Operation time (min) 98 ± 13 85 ± 14 0.001
(2006) 10 study; 148 • Decline of hemoglobin concentration 1.1 ± 0.5 2.2 ± 0.5 0.001
• Pain intensity 6 hr 4.1 ± 1.5 6.5 ± 1.5 0.001
• Pain intensity 24 hr 3.1 ± 1.5 2.8 ± 1.8 0.519
• Request of analgesic 25 (34.7%) 54 (73.0%) 0.001
• Time of postoperative ileus (hr) 28 ± 6 45 ± 6 0.001
• Time to discharge 38 ± 12 48 ± 12 0.001
• Patient recuperated on day 15 65 (90.3%) 55 (74.3%) 0.012
NS: Non significant
World Journal of Laparoscopic Surgery, September-December 2016;9(3):126-129 127