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Analysis of Risk Factors for Intraoperative Conversion of Laparoscopic Myomectomy.

Abstract：

OBJECTIVES:To report the surgical outcomes of laparoscopic myomectomy (LM) and abdominal myomectomy (AM) at a high-volume tertiary care hospital, to evaluate the risk of conversion during LM, and to analyze the associated risk factors. DESIGN:Retrospective cohort study (Canadian Task Force classification II). PATIENTS:All patients who underwent LM and AM in a tertiary academic center in Boston, Massachusetts between 2009 and 2012. INTERVENTION:Medical records were reviewed for baseline characteristics and perioperative outcomes. Robot-assisted laparoscopy was considered a subtype of LM. RESULTS:A total of 966 patients underwent myomectomy during the study period, including 731 LM cases (75.67%) and 235 AM cases (24.33%). Compared with patients undergoing LM, those undergoing AM had more myomas removed and heavier specimens (mean number of myomas, 12.60 vs 3.54, p ≤ .001; mean weight, 592.75 g vs 263.4 g, p ≤ .001). Conversion was necessary in 8 LM cases (1.09%). All conversions were reactive in nature and were associated with greater blood loss (mean, 1381.25 vs 167.95 mL; p ≤ .001) and longer hospital stay (mean, 3.13 vs 0.55 days; p ≤ .001) compared with cases without conversion. Factors associated with conversion included both the number and the weight of myomas removed (mean number, 9.75 vs 3.48, p = .003; mean weight, 667.9 vs 259.25 g, p = .015), especially with myomas weighing >500 g (odds ratio = 8.551; p = .005). CONCLUSION:The risk of conversion for LM was low (1.09%) in this cohort, and was associated both with the number and the weight of myomas removed. LM is a feasible approach for surgical management of myomas in the majority of cases; however, when myomas are expected to weigh >500 g, it may be prudent to consider referring those cases to specialized centers with highly experienced teams.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Sandberg EM,Cohen SL,Jansen FW,Einarsson JI

doi

10.1016/j.jmig.2015.10.017

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

352-7

issue

3

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(15)01659-3

journal_volume

23

pub_type

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