Uterine myomectomy: Role of gasless laparoscopy in comparison with other minimally invasive approaches

Introduction: The aim of this review was to assess the role of gasless laparoscopy (GLM) in comparison with two other minimally invasive approaches to myomectomy, CO2 laparoscopy (LM) and minilaparotomy (MM), focusing on the most recent randomized or prospective controlled studies. Material and methods: A computerized search was made of the Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first reports of GLM, LM, and MM in 1995 to 2010. The fifteen most recent randomized or prospective controlled studies were selected and analyzed considering the operative and postoperative parameters. Results: One randomized controlled, one multicenter controlled, three prospective studies about GLM, four randomized controlled studies and one prospective study about LM, four randomized controlled trials and one prospective study about MM were reviewed and analyzed. Discussion: GLM offers some advantages eliminating the adverse effects and potential risks of CO2 insufflation, particularly when large myomas have to be removed. The advantages of LM are the tamponade effect generated by the gas on the small vessels and the more precise myoma enucleation by using the endoscopic instruments, thus reducing intraoperative bleeding. MM can be a suitable option being associated with a lower overall level of surgical skill, even if it is desirable to have a standard universally accepted definition of minilaparotomy in order to correctly compare the results of the different studies. Lastly, the surgical outcomes of the three minimally invasive approaches to myomectomy are influenced by size, site, and number of the myomas, as well as by the skill and preference of the surgeon. All these criteria should be considered in the choice of the best minimally invasive approach to myomectomy.