Background: To determine the optimal surgical approach for laparoscopic uterine artery ligation (LUAL) combined with myomectomy in the management of women with symptomatic uterine fibroids. Methods: This is a prospective study. One hundred and six women with symptomatic uterine myomas underwent LUAL laparoscopic morcellation after enucleation (enucleation group) (n 51) or LUAL laparoscopic in situ morcellation (ISM group) (n 55). The outcome was measured by comparing surgical techniques, symptom control, recurrence and pregnancy during a 3-year follow-up in both groups. Results: General characteristics of the patients were similar in both groups, except the myomas were larger in the ISM group. The operative time (mean ± SD) was significantly shorter in the ISM group than the enucleation group (107 ± 30 min versus 128 ± 49 min, P 0.009). There were no differences in the therapeutic outcomes of the two groups at the 3-year follow-up, with low recurrence rates and good symptom control rates. Of the sexually active patients without contraception, the pregnancy and live birth rates were 87.5 and 100 in the ISM group and 66.7 and 83.3 in the enucleation group (all NS). Conclusions: The LUAL myomectomy, either by enucleation or ISM, is acceptable in the management of symptomatic uterine fibroids. However, the LUAL ISM technique might be more feasible, as it requires less operative time.
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