Comparative Study on Reproductive and Surgical Outcomes in Laparoscopic Myomectomy: Temporary Uterine Artery Cross-clamping for Large Submucosal Leiomyomas Compared to Alternative Methods

A significant proportion of women face primary infertility or pregnancy loss, while secondary infertility is reported in approximately half of women with myomatous nodules (MN). The surgical resection of these myomas has been shown to significantly enhance pregnancy outcomes. The aim of this study was to compare various surgical strategies for managing large sub-mucosal uterine fibroids at reproductive age, and to provide the most efficient and the least invasive approach in order to minimize trauma, blood loss, and expenses, and to enable women to fully carry pregnancies. Investigation centred on women with sub-mucosal myomatous nodules, which may lead to bleeding and infertility. The study included a total of ۱۶۰ patients diagnosed with ۴-۶ cm sub-mucosal uterine leiomyomas, classified as FIGO-۰,۱,۲. The patients were divided into four groups based on the used surgical method: ۱. Laparotomy myomectomy, ۲. laparos-copy without uterine artery cross-clamping, ۳. laparoscopy with uterine artery cross-clamping, and  ۴. resectoscopy myomectomy. The findings showed a notable reduction in blood loss during laparoscopy with cross-clamping (Mean: ۸۰.۰۰±۱۹.۷۸۵) compared to the other methods (Laparotomy – М: ۸۰۰,۲۵±۱۱۱,۱; Ls without cross-clamping – Мean: ۴۶۸.۷۵ ± ۷۹.۸۱۳; and GRS – Mean: ۵۴۵.۵۰ ± ۸۲.۱۴۹). Post-operative haemoglobin levels varied significantly across the groups (p = ۰.۰۰۰). Uterine synechias were more prevalent following resectoscopy than with alternative approaches. The mean time to pregnancy initiation was ۱۴.۷۵۰ ± ۰.۶۲۲ months with laparotomy, ۹ ± ۰.۳۹۲ months with laparoscopy without cross-clamping, ۶ ± ۰.۲۸۸ months with laparoscopy with cross-clamping, and ۵ ± ۰.۹۲۹ months with resectoscopy (p = ۰.۰۰۱). Laparoscopic myomectomy involving temporary uterine artery clipping exhibits potential for managing ۴-۶ cm sub-mucosal uterine leiomyomas. Prudent suturing of the uterus is imperative for favourable results. Our methodologies, such as laparoscopy with meticulous suturing, resulted in zero uterine ruptures during pregnancy and successful deliveries. This technique offers effective surgical treatment within a shorter period, particularly benefiting patients with mild to moderate anaemia, and obviates the necessity for postoperative blood transfusion. The findings underscore the significance of precise surgical techniques in achieving successful results for women with sub-mucosal myomas.

کلیدواژه ها:

Hysteroresectoscopy ، Infertility ، Laparoscopy ، Myoma ، myomectomy