a retrospective study of residual myomas following laparoscopic myomectomy

Background: With the development of laparoscopic instruments such as the morcellator, a large number of gynecologists have performed laparoscopic myomectomies. In this study, we reviewed all cases in which residual myomas were identified by follow-up magnetic resonance imaging in order to evaluate why any myomas would remain after a laparoscopic myomectomy and to find their most common location and depth within the uterus. Methods: Patients (n = 128) with uterine myomas who underwent a laparoscopic myomectomy between 2008 and 2011 and received follow-up magnetic resonance imaging 3 months afterward were reviewed retrospectively. We analyzed the influence of preoperative gonadotrophin-releasing hormone agonist treatment, as well as the location and depth of the residual myomas within the uterus. The pregnancy rate in all cases was also investigated. Results: The duration of the preoperative administration of gonadotrophin-releasing hormone agonist was statistically longer in cases where multiple residual myomas were found, compared with cases where a single residual myoma was present. There was no statistical difference in the rate and size of the residual myomas among five different locations within the uterus. The rate of residual subserosal myomas was lowest, compared with two other types, and was statistically lower than residual intramuscular myomas (p < 0.05). The pregnancy rate in cases of residual myomas revealed no statistical difference compared with nonresidual cases. Conclusion: Because the completion of laparoscopic myomectomy without any residual myomas is difficult, informed consent regarding the possibility of their occurrence is necessary, regardless of the number of myomas detected preoperatively. Moreover, intramuscular residual myomas should be given particular attention due to their higher rate of incidence.