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A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes.

Palomba S, Zupi E, Falbo A, Russo T, Marconi D, Tolino A, Manguso F, Mattei A, Zullo F

Department of Obstetrics & Gynecology, University Magna Graecia of Catanzaro, Catanzaro, Italy. stefanopalomba@tin.it

OBJECTIVE: To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive. DESIGN: Randomized controlled trial. SETTING: Departments of obstetrics and gynecology of the universities of Catanzaro, Rome, and Florence, Italy. PATIENT(S): One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility. INTERVENTION(S): Laparoscopic and minilaparotomic myomectomy. MAIN OUTCOME MEASURE(S): Pregnancy, abortion, and live-birth rates. RESULT(S): Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy, live-birth, and abortion rates, whereas pregnancy and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group. Categorizing the patients according to surgical indication for myomectomy, cumulative pregnancy rate, pregnancy, and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients, whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility. CONCLUSION(S): Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility, whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas.

Published 8 October 2007 in Fertil Steril, 88(4): 933-41.
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