Factors influencing surgical outcomes of laparoscopic myomectomy. A  propensity-score matched analysis

Introduction
To evaluate factors influencing surgical choice in performing uterine myomectomy by comparing laparoscopic and open approach surgery.

Material and methods
We analyzed women undergoing uterine myomectomy in our hospital. Patients were divided into two groups: patients who underwent laparoscopic myomectomy (group A) and patients who underwent laparotomic myomectomy (group B). We matched 1 : 1 women in these two groups to compare the effects of the procedures on each outcome according to a propensity-matched score analysis.

Results
460 myomectomies were performed in the study period: 361 cases by laparoscopy (group A) and 99 cases by laparotomy (group B). We found lower estimated intraoperative blood loss (200 ml group A vs. 300 ml group B, < 0.0001) and a smaller decrease in hemoglobin value on the first postoperative day (1.7 g/dl group A vs. 2.2 g/dl group B, < 0.0001) with the laparoscopic approach. The propensity score matching estimated that to obtain an equivalent outcome, we required an average of 2 myomas and an average diameter of 8 cm in laparoscopy and 10 cm in laparotomy. Moreover, the variables mostly associated with a laparotomic conversion were the presence of a myoma > 8 cm and association with the presence of more than 2 myomas.

Conclusions
Despite some proposals from previous studies, there are no specific guidelines regarding the best surgical procedure for myomectomy. Our data confirm that the choice of surgical technique should consider the patient characteristics and the surgeon experience to reduce longer operating times and more significant blood loss.