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Patient Selection Criteria for Outpatient Myomectomy via Mini-laparotomy”

Authors:
Greg Marchand at Marchand Institute for Minimally Invasive Surgery
Greg Marchand
  • Marchand Institute for Minimally Invasive Surgery
William H Kutteh at University of Tennessee Health Science Center
William H Kutteh
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“Patient Selection Criteria for Outpatient Myomectomy via Mini-laparotomy”
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Patient Selection Criteria for Outpatient Myomectomy via Mini-laparotomy
Greg J. Marchand, MD
University of Tennessee at Memphis, Memphis, Tennessee
William Kutteh, MD, PhD
OBJECTIVE: To establish criteria to serve as a guideline for physicians selecting patients for outpatient
abdominal myomectomy via mini-laparotomy.
METHODS: We developed an alternative procedure for myomectomy using mini-laparotomy. This
procedure includes a 6 cm Pfannenstiel incision, strict hemostasis, avoidance of bowel packing and
retraction, exteriorization of the uterus or leiomyoma through the incision, and same day discharge. We
performed a retrospective analysis of 45 patients undergoing outpatient mini-laparotomy myomectomy
against a control group of 84 patients in the same practice receiving inpatient myomectomy by traditional
laparotomy. We compared surgical outcomes, patient demographics, and data regarding uterine
leiomyoma available to the surgeon preoperatively.
RESULTS: There were no significant differences in age, gravidity, parity or race between the two
groups. Mini-laparotomy and outpatient myomectomy was successsfully performed on 98% of patients
attempted. Average operative time using our mini-laparotomy was 80 minutes, average blood loss was
125cc, and average time to discharge was 172 minutes. All parameters were significantly decreased from
the inpatient myomectomy group. None of the patients returned for hospitalization or reoperation. All
patients were fully ambulatory by one week postop. Predictors of successful outpatient myomectomy
included 3 or fewer myomas, largest myoma less than 7 cm, and a BMI less than 28.
CONCLUSION: These parameters describe criteria to use when evaluating a patient for outpatient
myomectomy procedure. There was a learning curve of physician acceptance of the outpatient procedure.
Patient satisfaction with the outpatient procedure was high, complications were lower, and total cost was
significantly decreased.
© 2009 The American College of Obstetricians and Gynecologists Tuesday Posters 43
... Minilaparotomy has gained popularity as a minimally invasive alternative not only to traditional open abdominal myomectomy but also to laparoscopic myomectomy [33,34]. In the hands of well-trained surgeons, minilaparotomy can be performed safely and effectively as a same-day procedure. ...
... In the hands of well-trained surgeons, minilaparotomy can be performed safely and effectively as a same-day procedure. Using appropriate patient selection criteria (body mass index less than 30 kg/m 2 , less than five fibroids total, largest fibroid ≤7 cm), our surgical unit averages an operating time of less than 100 min, blood loss of approximately 125 cc and total outpatient stay of 3.5 h [33]. Generally, a Pfannenstiel incision of 3-4 cm in length is made approximately 2-3 cm above the pubic symphysis. ...
Minimally Invasive Surgical Options for Congenital and Acquired Uterine Factors Associated with Recurrent Pregnancy Loss
Article
Full-text available
  • Mar 2015
Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies before 20 weeks' gestation and may be caused by genetic, endocrinologic, anatomic and immunologic abnormalities. Anatomic uterine anomalies include congenital malformations (bicornuate, didelphic, septate and unicornuate uteri) and acquired defects (fibroids, adenomas, adhesions and polyps). Women with septate and bicornuate uteri, intrauterine adhesions, and some adenomas and fibroids are at increased risk of RPL. Data support surgical treatment of all of these lesions except bicornuate uteri. The role of polyps in RPL is unclear. Minimally invasive options for surgical correction of intrauterine lesions include hysteroscopy, laparoscopy with and without robotic assistance and minilaparotomy.
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