One hundred laparoscopic myomectomies with ultrasonic energy: surgical evaluation of a new energy source

Objective

To evaluate the surgical efficiency of ultrasonic energy for laparoscopic myomectomies through review of the dissection and haemostatic capabilities of the energy source; the pregnancy results after surgery; formation of uterine fistulas and postoperative adhesions, and energy-related difficulties and complications.

Design

Retrospective chart review.

Setting

One surgeon, and the Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois.

Patients

100 women with symptomatic uterine leiomyomata.

Interventions

100 consecutive laparoscopic myomectomies were performed between April 1993 and May 1997. Ultrasonic cutting and coagulation (Ultrasonic Scalpel) was used on all cases for dissection of myomas from the myometrium.

Results

The indications for surgery were: menometrorrhagia (44%), chronic pain (29%) and increasing uterine size (27%), and 99 procedures were completed laparoscopically. One procedure was converted to an open laparotomy to remove a broken needle fragment from the Endostitch^TM (1% conversion rate). No energy-related complications occurred. A total of 320 myomas were removed laparoscopically from 99 patients. Dissection and achievment of haemostasis was easy and rapid with all types of myomas. To date, 10 patients have experienced 12 pregnancies. No fistulas or uterine dehiscence have occurred. A total of 26 patients had second-look evaluations, and 65% of these were clinically free of adhesions (grade 0 or grade 1).

Conclusions

When compared with published results of laparoscopic myomectomies performed with lasers and electrosurgical instruments, ultrasonic energy demonstrated equal dissection and haemostatic capabilities without the risks of toxic smoke, burns and thermal injuries. Ultrasonic energy is an effective energy source for laparoscopic myomectomies.