Archives of Gynecology and Obstetrics (2018) 297:969–976
Morbidity, fertility and pregnancy outcomes after myoma enucleation
by laparoscopy versus laparotomy
· C. Iwanuk
· I. Staboulidou
· G.‑J. Garcia‑Rocha
· P. Soergel
· H. Hertel
· P. Hillemanns
Received: 24 May 2017 / Accepted: 30 January 2018 / Published online: 7 February 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Objectives Myomas are deﬁned as benign tumours that arise from smooth muscle cells of the uterus. Clinically, they are
found in 5–77% of women of reproductive age. The prevalence rate varies considerably in the literature and a large number
of ﬁbroids do not cause symptoms. The lifetime risk of acquiring myomas is 70% for Caucasian women and ≥ 80% for
African American women.
Materials/methods The data of 265 patients undergoing surgery for symptomatic myomas by laparoscopy or laparotomy,
performed in the gynaecological department of Hannover Medical School, Hannover, Germany, between 2009 and 2013,
were retrospectively analysed in this retrospective design study.
Results High pregnancy rates (up to 70%) and birth rates (up to 86%) after myomectomy, regardless of the surgical approach
adopted, were found in the current study. The trend was that ≥ 3 myomas and those that were ≥ 6 cm in size were almost
always removed by laparotomy in our clinic. It was possible to remove up to 42 myomas without having to perform a hysterec-
tomy. A statistically signiﬁcant negative correlation was observed in relation to the association between the size of the largest
myoma extracted and the pregnancy rate (p = 0.02). A statistically signiﬁcant correlation between the number of removed
myomas and the pregnancy rate was observed for patients who wished to bear children (p = 0.010). Elevated complication
rates (of up to 50%) were reported for more than three extracted myomas with a statistically signiﬁcance (p = 0.0471).
Conclusions It is necessary to ensure sound preoperative selection of the surgical approach in order to achieve the most
optimal results, especially for those patients who wished to bear children.
Keywords Myoma · Myomectomy · Pregnancy rate · Birth rate · Laparoscopy · Laparotomy · Surgical approach ·
Myomas are defined as benign tumours that arise from
smooth muscle cells of the uterus. Clinically, they are found
in 5–77% of women of reproductive age [1, 2]. The preva-
lence rate varies considerably in the literature and a large
number of ﬁbroids do not cause symptoms . The lifetime
risk of acquiring myomas is 70% for Caucasian women
and ≥ 80% for African American women .
The pathogenesis of ﬁbroids is not fully understood.
Implicated factors include ovarian steroid hormones (oes-
trogen and progesterone), genetic predisposition (e.g., the
HMGIC and MED12 genes), growth factors (e.g., vascular
endothelial growth factor-A and transforming growth factor),
the upregulation of type I and type III collagen, and inter-
leukin-8 . Common symptoms of myomas are bleeding
disorders, lower abdominal pain, pressure-related symptoms,
and sterility and infertility. Myoma-associated symptoms
vary individually according to size, location and the number
of lesions [5, 6]. Complications during pregnancy include
early and late miscarriage, the premature onset of labour
and rupture of membranes, placental adhesion detachment
disorders, postpartum haemorrhage and atonia [7–9].
Sudip Kundu and C. Iwanuk shared ﬁrst authorship.
* Sudip Kundu
Department of Obstetrics and Gynaecology, Hannover
Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover,