Laparoscopy assisted minilaparotomy (LA-MLT) for big fibroids.

Abstract

Objectives: Uterine fibroids are frequently associated with symptoms like subfertility, heavy menstrual bleeding etc. When symptomatic they need to be treated medically or surgically. We assessed the efficacy and safety of laparoscopy assisted mini-laparotomy for fibroids causing a big uterine size (>12 weeks). Study Design: Observational study. Setting: At Hameed Latif Hospital Lahore, Pakistan. Period: From Feb 2018 to Jan 2019. Material & Methods: Forty six patients were selected by non-probability convenience sampling. Size of uterus, number of fibroids were recorded. All patients underwent hysteroscopy followed by laparoscopy assisted mini-laparotomy for myomectomy. A small 5cm incision was used extending its length only where needed. Length of incision, time for procedure, volume of blood loss were recorded. Data was analyzed with MS Excel 2013. Results: All participants were sub fertile women with uterine fibroids and size of uterus more than 12 weeks. Menorrhagia was a common symptom seen in 36.9% patients. Hysteroscopy revealed uterine deformities in 43% patients. Laparoscopy showed bilateral tubal blockage in 23 % participants. Average size of uterus per-operatively was 19.4 weeks. Mean duration of surgery was 54.13 min (SD ±18.05) and average blood loss was 650 ml (SD±238.28). No procedure was converted into conventional laparotomy and average length of incision was 4.9 cm (SD±0.91). Conclusion: LA MLT is a safe and effective approach to remove big fibroids. Hysteroscopy in the same sitting allows detection & correction of uterine abnormalities. Additional advantage of laparoscopy is ability to check tubal patency in the same sitting in sub fertile women.