복강경 이용 자궁선근증 절제와 복강경 혹은 개복을 통한 자궁선근증 절제술의 비교

Abstract

Objective: To assess the safety and benefit of laparoscopic assisted adenomyomectomy compared with laparoscopic or laparotomic adenomyomectomy. Materials and methods This is a retrospective comparative study. Between January 2016 and January 2019 at the Department of obstetrics and Gynecology, Ulsan University Hospital, total 277 patients underwent adenomyomectomy, of which 25 had laparoscopic assisted adenomyomectomy, 82 with laparoscopic adenomyomectomy, and 170 with laparotomic adenomyomectomy laparoscopic assisted adenomyomectomy was consisted of laparoscopic uterine artery procedures for reducing blood loss and minimally incisional laparotomic adenomyomectomy. Also, additional laparoscopic surgery was performed about possible pelvic pathology. Results: Data on patient demographics, surgical indications, operative times, estimated blood loss (EBL), short-term complications, and postoperative hospital stays were compared. The laparoscopic assisted surgery(LAS) and laparotomic groups were comparable in terms of the average EBL (208.0±128.8 vs. 193.6±193.0 mL, p=0.11), weight of removed mass (85.5±71.7 vs. 108.2±91.9 g, p=0.39), and postoperative hospital days (HDs) (4.5±1.0 vs. 4.7±0.8 days, p=0.27). These values were lower in the laparoscopic group (EBL 119.5±79.6 ml, mass weight 39.3±25.9 g, HD 3.6±0.8 days). Additional procedures, including myomectomy and combined severe endometriosis surgery, were more frequently performed in the LAS group than in the laparotomic group. The mean operating time was longer in the LAS group (179.8±36.6 min) than in the other groups (laparoscopy 99.9±40.6 min, p<0.00; laparotomy 133.0±41.1 min, p<0.00). The three groups did not differ significantly in terms of transfusion rates, hemoglobin changes, or perioperative complications; however, febrile morbidity was lower in the laparoscopic group than in the LAS and laparotomic group. Conclusion: LAS adenomyomectomy allows for maximal debulking of adenomyosis via extracorporeal and intracorporeal procedures, while retaining the advantages of the laparoscopic approach. With this approach, additional pelvic surgery for benign uterine and adnexal pathology can easily be performed.