TRAITEMENT COELIOCHIRURGICAL DES VOLUMINEUX FIBROMES UTERINS. TECHNIQUE OPERATOIRE ET RESULTATS

Objective. To describe the technique of laparoscopic myomectomy for large myomas (5 cm and more) and to evaluate the results. Results. Only myomas which are complicated (and/or resistant to properly conducted medical treatment) require surgical treatment. Between October 1, 1990 and October 31, 1994, we carried out 72 laparoscopic myomectomies for intramural myomas measuring 5 cm or more, in 71 patients. The operations lasted 130 ± 60 min (range: 40-330 min). We converted to laparotomy for two cases (2.7%). We observed no serious per or postoperative complications. We never needed a repeat operation, whether by laparotomy or by laparoscopy. Conclusion. Despite these encouraging results, it must be remembered that the operation is lengthy and difficult and is reserved for laparoscopic surgeons perfectly familiar with endoscopic knot tying. Although it is a diffcult technique, laparoscopic myomectomy is possible even for large myomas and those that are completely intramural. These results need to be assessed over the long term especially with respect to the risk of adhesions and the quality of the laparoscopic suture.