Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience

Purpose To determine whether a correlation exists between size, location, type of myomas and perioperative outcomes. Methods This is a observational study in women undergone to laparoscopic myomectomy (LM) because of single symptomatic myoma >4 cm in diameter. We collected data about general features, surgical outcomes, intraoperative/ postoperative complications and time to return to normal activity. Results A total of 444 patients (mean age 36.7+/-6.4 years) resulted eligible for the study. Myomas sized between 8 and 12 cm were linked to an increased amount of blood loss (significantly higher in intramural than subserosal myoma). The removal of intramural myomas >8 cm and the subserosal ones >12 cm required a significant longer surgical time. Patients returned 17.9 +/- 9.5 days after surgery to their personal activities. Six cases (1.35 %) required conversion to laparotomy, and only in two cases blood transfusion was necessary. Conclusion Myomas size and type represent the best predictors of surgical difficulties and possible intrapostoperative complications. Intramural myomas > 8 cm and subserosal ones > 12 cm should be considered as a challenging procedure. LM remains the gold standard approach because of very low perioperative complication rate and faster return to normal activity.