Surgical approach to uterine myomatosis in patients with infertility: open, laparoscopic, and robotic surgery; results according to the quantity of fibroids.

OBJECTIVE: To compare approaches to myomectomy (laparotomic, laparoscopic, and robotic). To show the relationship between the number of fibroids and the reproduction diagnosis. METHODS: Observational, analytical, retrospective, and cross-sectional study; where the surgical approach used, was evaluated in terms of surgical bleeding, time, number and weight of fibroids and reproductive results. RESULTS: 69 patients were treated through different approaches and divided into 3 groups. The differences found among groups were in favor of laparotomic myomectomy in terms of the number (p=0.000) and weight of fibroids (p=0.004). Robotic surgery was also longer (p=0.000). In the analysis of the influence of the number of fibroids to achieve pregnancy, the result was in favor of the minimally invasive routes, after surgery, both in the group of < 6 fibroids (p=0.017), and that of > 6 fibroids (p=0.001), without differences in the time from surgery to pregnancy (p=0.979). CONCLUSIONS: The surgical approach decision should consider the number and size of resected fibroids, surgical time, and reproductive diagnosis. The minimally invasive route should be offered whenever possible due to its better outcome on achieving pregnancy, without forgetting the benefits of laparotomy, while also accrediting the recently introduced robotic-assisted approach.

[Persistent ectopic pregnancy. Peritoneal-uterine late implantation. Case report]. / Embarazo ectópico persistente. Implantación tardía utero-peritoneal. Comunicación de un caso.

We report a case of a 31 years-old female previously treated with laparoscopic salpingectomy due to fimbrial ectopic unruptured pregnancy. After 33 days it was performed a repeated laparoscopy due to persistent b-hCG levels and abdominal pain. During surgical performance there were located three ectopic implantations (one uterine and two peritoneal) of active trophoblastic cells with intermittent bleeding. Fulguration with bipolar current was practiced and administered an intramuscular dose of methotrexate. b-hCG monitoring curve descend until it was negative ten days later. In spite of skillful technique and careful review of pelvic cavity there still are active throphoblastic cells that may cause surgical urgency. Supplementary therapy with a single dose of methotrexate can be an innocuous option.