Page 30 - World Journal of Laparoscopic Surgery

Laparoscopic Myomectomy: Does it have any Advantages over Conventional Laparotomy?

in hospital longer and even took long to recover and resume reviews indicating clear advantages over the open conventional
duty. 12 type of myomectomy. 13,14,18 The time taken to recovery is also
A Cagnacci et al in a randomized prospective study looked short following laparoscopic myomectomy. This clearly is an
at pain control in their patients and duration of hospital stay advantage to the patient and the surgeon. Hospital bed space
before discharge. Of the patients operated by laparoscopy, only is also created for other patients to occupy. Early return to duty
a very small number required analgesia by 72 hours after surgery, is also an added advantage although still patients may suffer
while almost all who underwent laparotomy were still on from fatigue as a result of the anesthesia; they still recuperate
analgesics 72 hours after surgery. On hospital stay ten of the 17 at home. 12-15 Patient satisfaction is also another factor. The
patients of laparoscopic surgery had been discharged while operation site does not have a big incision as is the case with
none in the laparotomy group. 13 conventional myomectomy. This is especially satisfying in the
Mais V et al in another randomized clinical study in 1996 cosmetically conscious patients.
involving 40 subjects had similar findings that pain control was Despite all the mentioned advantages, laparoscopic
better tolerated by those in the laparoscopy group than the myomectomy is an expensive procedure and the surgeon must
laparotomy group. While only 3 patients needed analgesics in be sure of what she/he is doing. Proper and complete training is
the laparoscopy group, 17 of the laparotomy patients needed a must as there are no short cuts to operative laparoscopy. The
analgesia. By the 15th day of surgery, 18 of the patients who patient must be explained what to expect including the possibility
had laparoscopic surgery had left hospital while only one had
been discharged from the laparotomy group. 14 of conversion if need be.
C Chapron et al in a meta-analysis in 2002 of published data, Laparoscopic Myomectomy has been given a lot of attention
from a randomized clinical trial looked at risks facing patients and publicity worldwide but still it remains such a controversial
after laparoscopic myomectomy. (1809-laparoscopy and 1802- subject. Several studies conducted are either against or for
laparotomy). He found that the overall risk of complications laparoscopic myomectomy-a clear case of bias. This should
was significantly lower for the patients operated by however not discourage those for it as they are the ones who
laparoscopy. 17 will improve and refine the surgery.
Holzer et al is accredited with the first double-blind study in From the foregoing, it is clear that despite the many
pain control after laparoscopic myomectomy. After sugery, all controversies and the bias against laparoscopic myomectomy,
the patients had similar dressings and therefore none of them the several studies reviewed may not have given a clear picture
new which patients had which type of surgery.19 had of the way forward, but a clear foundation has been laid down
laparoscopy and 21 had laparotomy. The investigators were to have more studies carried out in the future to clearly show
also kept in the dark. On completion of the study, analysis done whether there are clear advantages of laparoscopic myomectomy
clearly showed that laparoscopic surgery had clear advantages over the conventional way- laparotomy. Most of the drawbacks
over laparotomy as far as pain control is concerned. 18 in the study resulted from the fact that;
Alfonso Rossetti et al in their review published in April 1. There were no clear reviews for research.
2001 looked at the rate of myoma recurrence following either 2. There was very minimal scientific blinding, which is usually
laparoscopic or laparotomy myomectomy. 162 patients were the main stay of scientific research.
involved, 82 for each type of surgery. These were followed up 3. Some investigators might have clear publication bias of
to 40 months. At the end of this duration, 11 in the laparoscopy results.
and 9 in the laparotomy had recurred. Analysis of this did not
show any statistical significance. 19 REFERENCES

1. R K Mishra. Textbook of Practical Laparoscopic Surgery, Chap
DISCUSSION AND CONCLUSION
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