Question: 40 year lady with subserosal fibroid (10x10cm) treated with laparoscopic myomectomy using morcellator may be associated with adverse outcome?
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Answer: Three cases of peritoneal myomatosis after laparoscopic myomectomy and morcellation have been reported. (1-3)
A cohort study of almost 1000 laparoscopic myomectomies (LM) with extraction by electric morcellation (4) reported a conversion rate to laparotomy of 1.29% and no major intraoperative complications. There were three serious postoperative complications. The overall rate of intrauterine pregnancy following LM was 62.53% and the abortion rate was 15.9%
(Evidence level III)
An earlier systematic review of morcellator-related injuries across all specialities found 14 non-trivial visceral injuries and 3 patient deaths. (5)
References:
- Kumar S. Sharma JB. Verma D. Gupta P. Roy KK. Malhotra N. Disseminated peritoneal leiomyomatosis: an unusual complication of laparoscopic myomectomy. Archives of Gynecology & Obstetrics. 278(1):93-5, 2008 Jul. Abstract , Full text available to Fellows, Members and Trainees
- Takeda A. Mori M. Sakai K. Mitsui T. Nakamura H. Parasitic peritoneal leiomyomatosis diagnosed 6 years after laparoscopic myomectomy with electric tissue morcellation: report of a case and review of the literature. Journal of Minimally Invasive Gynecology. 14(6):770-5, 2007 Nov-Dec. Abstract
- Paul PG. Koshy AK. Multiple peritoneal parasitic myomas after laparoscopic myomectomy and morcellation. Fertility & Sterility. 85(2):492-3, 2006 Feb Abstract
- Malzoni M. Sizzi O. Rossetti A. Imperato F. Laparoscopic myomectomy: a report of 982 procedures. Surgical Technology International. 15:123-9, 2006. Abstract
- Milad MP. Sokol E. Laparoscopic morcellator-related injuries. Journal of the American Association of Gynecologic Laparoscopists. 10(3):383-5, 2003 Aug. Abstract
Search date: March 2009
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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