A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: reproductive outcomes

Objective: To assess the reproductive outcomes after minilaparotomic and laparoscopic myomectomy in patients wishing to conceive. Design: Randomized controlled trial. Setting: Departments of obstetrics and gynecology of the universities of Catanzaro, Rome, and Florence, Italy. Patient(s): One hundred thirty-six women with symptomatic uterine leiomyomas or unexplained infertility. Intervention(s): Laparoscopic and minilaparotomic myomectomy. Main Outcome Measure(s): Pregnancy, abortion, and live-birth rates. Result(s): Between the laparoscopic and minilaparotomic groups no difference was observed in cumulative pregnancy, live-birth, and abortion rates, whereas pregnancy and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly higher in the laparoscopic than in the minilaparotomic group. Categorizing the patients according to surgical indication for myomectomy, cumulative pregnancy rate, pregnancy, and live-birth rates per cycle, and time to first pregnancy and live-birth were significantly better after laparoscopic myomectomy in symptomatic patients, whereas all reproductive outcomes were similar between the two groups in patients with unexplained infertility. Conclusion(s): Minilaparotomic and laparoscopic myomectomy improves in a similar manner the reproductive outcomes in patients with unexplained infertility, whereas the laparoscopic approach provides the best benefits in fertile patients with symptomatic leiomyomas.