Ultra-minilaparotomy myomectomy: a minimally invasive surgical approach for the treatment of large uterine myomas.

Background: In recent years, a growing number of more conservative methods for the treatment of uterine myomas has been reported. However, only a small number of techniques is used for the treatment of large myomas. Aims: In the present retrospective study, we report our experience with a group of patients who consecutively underwent ultra-minilaparotomy myomectomy for single or multiple large myomas, with diameter greater than 5 cm, with emphasis on the safety and efficacy of this procedure. Methods: Forty-one women underwent an ultra-minilaparotomy myomectomy that involved a <4 cm transverse skin incision, with or without laparoscopic assistance. Results: Mean operating time was 92.4 min, the mean hemoglobin decline was 2.0 g/dl and the mean hematocrit decline was 5.7%. The mean time to discharge was 84.3 h. No patient underwent a second surgery for early postoperative complications. Postoperative fever occurred in 4 patients, especially in patients who underwent ultra-minilaparotomy without assisted laparoscopy. There were two cases of severe anemia with recourse to blood transfusion. Conclusion: The results of this study suggest that ultra-minilaparotomy myomectomy with or without laparoscopic assistance might represent a safe and effective minimally invasive alternative to standard open myomectomy in the treatment of large myomas