Gasless laparoscopic myomectomy. Indications, surgical technique and advantages of a new procedure for removing uterine leiomyomas.

OBJECTIVE: To evaluate the feasibility, safety and reliability of gasless laparoscopic myomectomy (GLM) using a new subcutaneous lifting system (Laparotenser, Lucini L&T, Milan, Italy) for removing subserosal and intramural leiomyomas. STUDY DESIGN: A total of 279 women with at least 1 symptomatic subserosal or intramural myoma measuring > 30 mm underwent GLM between April 1997 and July 2001. All procedures were performed by the same surgeons using the same technique. RESULTS: GLM was successful in all 279 patients. The mean size of the myomas were 5.9 cm. Their average number per patient was 3.1. The mean operating time was 73 minutes. Forty-eight patients subsequently carried a pregnancy to term. No cases of uterine rupture during pregnancy or labor were observed. CONCLUSION: GLM is a feasible, reliable and safe procedure for removing intramural and subserosal myomas. It appears to offer several advantages over laparoscopy with pneumoperitoneum. In addition, the largest and multiple medium-sized myomas can be removed rapidly and safely.