Archives of Gynecology and Obstetrics

, Volume 297, Issue 4, pp 969–976 | Cite as

Morbidity, fertility and pregnancy outcomes after myoma enucleation by laparoscopy versus laparotomy

  • Sudip Kundu
  • C. Iwanuk
  • I. Staboulidou
  • G.-J. Garcia-Rocha
  • P. Soergel
  • H. Hertel
  • P. Hillemanns
  • C. Schippert
General Gynecology



Myomas are defined as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are found in 5–77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number of fibroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for African American women.


The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy, performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013, were retrospectively analysed in this retrospective design study.


High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterectomy. A statistically significant negative correlation was observed in relation to the association between the size of the largest myoma extracted and the pregnancy rate (p = 0.02). A statistically significant correlation between the number of removed myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication rates (of up to 50%) were reported for more than three extracted myomas with a statistically significance (p = 0.0471).


It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most optimal results, especially for those patients who wished to bear children.


Myoma Myomectomy Pregnancy rate Birth rate Laparoscopy Laparotomy Surgical approach Morbidity 


Author contributions

SK: Project development, manuscript writing, data management. CI: Data collection. IS: Protocol development. GG-R: Project development. HH: Data management. PS: Manuscript editing. PH: Protocol development. CS: Project development, manuscript editing, data management.


There was no funding.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of Hanover Medical School on 16th of February 2015 (No: 2593-2015).


  1. 1.
    Drinville SJ, Memarzadeh S (2007) Benign disorders of the uterine corpus. Curr Diagn Treat Obstet Gynecol 10:639–653Google Scholar
  2. 2.
    Lethaby A, Vollenhoven B (2002) Fibroids. Clin Evid 14:1666–1678Google Scholar
  3. 3.
    Okolo S (2008) Incidence, aetiology and epidemiology of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22(4):571–588CrossRefPubMedGoogle Scholar
  4. 4.
    Day Baird D, Dunson DB, HillMC Cousins D, Schectman JM (2003) High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 188(1):100–107CrossRefGoogle Scholar
  5. 5.
    Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C (2014) Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 21(10):CD004638. Google Scholar
  6. 6.
    Floss K, Garcia-Rocha GJ, Kundu S, von Kaisenberg CS, Hillemanns P, Schippert C (2015) Fertility and pregnancy outcome after myoma enucleation by minilaparotomy under microsurgical conditions in pronounced uterus myomatosus. Geburtshilfe Frauenheilkd 75(1):56–63CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Pritts EA, Parker WH, Olive DL (2009) Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 91:1215–1223CrossRefPubMedGoogle Scholar
  8. 8.
    Practice Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons (2008) Myomas and reproductive function. Fertil Steril 90(5 Suppl.):125–130Google Scholar
  9. 9.
    Shavell VI, Thakur M, Sawant A et al (2012) Adverse obstetric outcomes associated with sonographically identified large uterine fibroids. Fertil Steril 97:107–110CrossRefPubMedGoogle Scholar
  10. 10.
    Golan A (1996) GnRH analogues in the treatment of uterine fibroids. Hum Reprod 11(Suppl 3):33–41CrossRefPubMedGoogle Scholar
  11. 11.
    Lethaby A, Vollenhoven B, Sowter MC (2001) Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. PubMedGoogle Scholar
  12. 12.
    Donnez J, Tatarchuk TF, Bouchard P et al (2012) Ulipristal acetate versus placebo for fibroid treatment before surgery. N Engl J Med 366:409–420CrossRefPubMedGoogle Scholar
  13. 13.
    Donnez J, Tomaszewski J, Vazquez F et al (2012) Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 366:421–432CrossRefPubMedGoogle Scholar
  14. 14.
    Levy BS (2008) Modern management of uterine fibroids. Acta Obstet Gynecol Scand 87(8):812–823CrossRefPubMedGoogle Scholar
  15. 15.
    Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret J, Houdart E, Aymard A et al (1995) Arterial embolisation to treat uterine myomata. Lancet 346:671–672CrossRefPubMedGoogle Scholar
  16. 16.
    Walker WJ, Pelage JP (2002) Uterine artery embolisation for symptomatic fibroids: clinical results in 400 women with imaging follow up. BJOG 109:1262–1272CrossRefPubMedGoogle Scholar
  17. 17.
    Jacob D, Rafii A (2004) Embolization of uterine arteries for uterine fibroids: state-of-the-art. Gynecol Obstet Fertil 32:927–936CrossRefPubMedGoogle Scholar
  18. 18.
    Griffiths A, D’Angelo A, Amso N (2006) Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 3:CD003857Google Scholar
  19. 19.
    Pirard C, Squifflet J, Gilles A et al (2002) Uterine necrosis and sepsis after vascular embolization and surgical ligation in a patient with postpartum hemorrhage. Fertil Steril 78:412–413CrossRefPubMedGoogle Scholar
  20. 20.
    David M, Kröncke T (2013) Uterine fibroid embolisation—potential impact on fertility and pregnancy outcome. Geburtshilfe Frauenheilkd 73:247–255CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Merill RM, Layman AB, Oderda D, Asche C (2008) Risk estimates of hysterectomy and selected conditions commonly treated with hysterectomy. Ann Epidemiol 18(3):253–260CrossRefGoogle Scholar
  22. 22.
    Donnez J, Jadoul P (2002) What are the implications of myomas on fertility? A need for a debate? Hum Reprod 17:1424–1430CrossRefPubMedGoogle Scholar
  23. 23.
    Mais V, Ajossa S, Guerriero S et al (1996) Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 174:654–658CrossRefPubMedGoogle Scholar
  24. 24.
    Jin C, Hu Y, Chen XC et al (2009) Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 145:14–21CrossRefPubMedGoogle Scholar
  25. 25.
    Mukhopadhaya N, De Silva C, Manyonda IT (2008) Conventional myomectomy. Best Pract Res Clin Obstet Gynaecol 22:677–705CrossRefPubMedGoogle Scholar
  26. 26.
    Al-Talib A (2013) Factors contributing to failure of laparoscopicmyomectomy. Surg Technol Int 23:149–151PubMedGoogle Scholar
  27. 27.
    Wen KC, Sung PL, Lee WL et al (2011) Myomectomy for uterine myomas through ultramini-laparotomy. J Obstet Gynaecol Res 37:383–392CrossRefPubMedGoogle Scholar
  28. 28.
    Munro MG, Critchley HO, Broder MS, Fraser IS (2011) FIGO Working Group on Menstrual Disorders: FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113(1):3–13CrossRefPubMedGoogle Scholar
  29. 29.
    Metwally M, Cheong YC, Horne AW (2012) Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev 11:CD003857PubMedGoogle Scholar
  30. 30.
    Falcone T, Parker WH (2013) Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol 121:856–868CrossRefPubMedGoogle Scholar
  31. 31.
    Alessandri F, Lijoi D, Mistrangelo E, Ferrero S, Ragni N (2006) Randomized study of laparoscopic versus minilaparotomic myomectomy for uterine myomas. J Minim Invasive Gynecol 13(2):92–97. (CENTRAL: CN–00563190) CrossRefPubMedGoogle Scholar
  32. 32.
    Cicinelli E, Tinelli R, Colafiglio G, Saliani N (2009) Laparoscopy vs minilaparotomy in women with symptomatic uterine myomas: a prospective randomized study. J Minim Invasive Gynecol 16(4):422–426. (CENTRAL: CN–00721670) CrossRefPubMedGoogle Scholar
  33. 33.
    Holzer A, Jirecek ST, Illievich UM, Huber J, Wenzl RJ (2006) Laparoscopic versus open myomectomy: a doubleblind study to evaluate postoperative pain. Anesth Analg 102(5):1480–1484 (CENTRAL: CN–00564509) CrossRefPubMedGoogle Scholar
  34. 34.
    Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulletti C et al (2000) Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod 15(12):2663–2668 (CENTRAL:CN–00330415) CrossRefPubMedGoogle Scholar
  35. 35.
    Sesti F, Capobianco F, Capozzolo T, Pietropolli A, Piccione E (2008) Isobaric gasless laparoscopy versus minilaparotomy in uterine myomectomy: a randomized trial. Surg Endosc 22(4):917–923 (CENTRAL: CN–00636939) CrossRefPubMedGoogle Scholar
  36. 36.
    Tan J, Sun Y, Dai H, Zhong B, Wang D (2008) A randomized trial of laparoscopic versus laparoscopic-assisted minilaparotomy myomectomy for removal of large uterine myoma: shortterm outcomes. J Minim Invasive Gynecol 15(4):402–409 (CENTRAL: CN–00649521) CrossRefPubMedGoogle Scholar
  37. 37.
    Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB (1996) Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol 174(2):654–658 (CENTRAL: CN–00123957) CrossRefPubMedGoogle Scholar
  38. 38.
    Casini ML, Rossi F, Agostini R, Unfer V (2006) Effects of the position of fibroids on fertility. Gynecol Endocrinol 22(2):106–109CrossRefPubMedGoogle Scholar
  39. 39.
    Kolankaya A, Arici A (2006) Myomas and assisted reproductive technologies: when and how to act? Obstet Gynecol Clin N Am 33(1):145–152CrossRefGoogle Scholar
  40. 40.
    Ribeiro SC, Reich H, Rosenberg J, Guglielminetti E, Vidali A (1999) Laparoscopic myomectomy and pregnancy outcome in infertile patients. Fertil Steril 71:571–574CrossRefPubMedGoogle Scholar
  41. 41.
    Dubuisson JB, Fauconnier A, Fourchotte V, Babaki-Fard K, Coste J, Chapron C (2001) Laparoscopic myomectomy: predicting the risk of conversion to an open procedure. Hum Reprod 16(8):1726–1731CrossRefPubMedGoogle Scholar
  42. 42.
    Dubuisson JB (2000) Management of leiomyomata. Hum Reprod Update 6(6):587CrossRefPubMedGoogle Scholar
  43. 43.
    Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T (2011) Robotic-assisted laparoscopic and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol 117(2 Pt 1):256–265CrossRefPubMedGoogle Scholar
  44. 44.
    Sentilhes L, Vayssière C, Beucher G et al (2013) Delivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 170:25–32CrossRefPubMedGoogle Scholar
  45. 45.
    Kim MS, Uhm YK, Kim JY, Jee BC, Kim YB (2013) Obstetric outcomes after uterine myomectomy: laparoscopic versus laparotomic approach. Obstet Gynecol Sci 56:375–381CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Bernardi TS, Radosa MP, Weisheit A et al (2014) Laparoscopic myomectomy: a 6-year follow-up single-center cohort analysis of fertility and obstetric outcome measures. Arch Gynecol Obstet 290:87–91CrossRefPubMedGoogle Scholar
  47. 47.
    Stotland NE, Lipschitz LS, Caughey AS (2002) Delivery strategies for women with a previous classic cesarean delivery: a decision analysis. Am J Obstet Gynecol 187:1203–1208CrossRefPubMedGoogle Scholar
  48. 48.
    Fukuda M, Tanaka T, Kamada M et al (2013) Comparison of the perinatal outcomes after laparoscopic myomectomy versus abdominal myomectomy. Gynecol Obstet Invest 76:203–208CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyHannover Medical SchoolHannoverGermany

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