Impact of surgical approach on blood loss during intracapsular myomectomy

Background: Myomectomy is one of the most common surgical procedures in gynecology and has implications on fertility and subsequent pregnancies. We compared the impact of surgical approach on blood loss during laparoscopic and abdominal intracapsular myomectomy. Material and methods: The evaluation comprised 124 fertile women with subserous or intramural myomas: 66 patients treated by laparoscopy and 58 patients treated by laparotomy. The intracapsular myoma enucleation technique was similar for both approaches. All procedures were analyzed for the evaluation of intra- and postsurgical blood loss and intra- and short-term post-operative surgical outcomes. Results: The operating time for laparoscopic intracapsular myomectomy was longer (95 ± 7.2 min vs. 63 ± 5.6, p < 0.0001), but was associated with reduced intra- (65 ± ml vs. 105 ± 5, p < 0.0001) and post-surgical blood loss (30 ± 5 vs. 60 ± 5 ml, p < 0.0001), as well as diminished application of pain relief medication (8 patients vs. 17, p < 0.05), compared to open intracapsular myomectomy. Conclusions: The surgical approach did not substantially affect the technique of intracapsular myomectomy; however, laparoscopy significantly reduced intra- and postoperative blood loss and resulted in better short-term outcomes than after open surgery. Our results underscore the advantages of trying to reduce the rate of laparotomic myomectomy, one of the leading surgical interventions associated with infertility and sterility.