THE COMPARISON OF OUTCOMES AFTER LAPAROSCOPIC MYOMECTOMY WITH THE USE OF DIFFERENT UTERINE SUTURE TECHNIQUES
Authors: Habrat B. , Lytvak O. , Lysenko B. , Habrat A. 
Published: April 2020

Purpose: to improve the outcomes and speed up the recovery after laparoscopic myomectomy in females with uterine leiomyoma, based on the comprehensive study and comparison of different uterine suturing techniques.

Material and methods. The study enrolled 130 patients, including 100 females underwent laparoscopic myomectomy. Based on the simple randomization, the sample of 100 surgically treated females was subdivided into two subsamples depending on the applied uterine suturing technique:         group I – extracorporeal knotting (n=50); and group II – intracorporeal continuous suturing (n=50). The control group included 30 apparently healthy females (group III). The clinical examination was performed before surgery in the outpatient setting, and in the hospital – after procedure and at the discharge (day 2). We assessed the parameters of myometrium tissue perfusion and the severity of inflammation in the surgical alteration area 1 month before and 1 month following the procedure. The ultrasound signs of myometrium regeneration completeness in the uterine scar area were determine 3 months after surgery. The late outcomes after myomectomy and catamnesis of reproductive function were evaluated at 6-month and 1-year follow-up.

Results and discussion. We established that the use of intracorporeal continuous suturing technique in patients underwent laparoscopic myomectomy was favorable for preservation of microcirculatory bed in myometrium, related to a more uniform distribution of suture tension in the tissue and a more even distribution of pressure exerted on the wound edges, as compared to extracorporeal knotting technique. These advantages of intracorporeal continuous suturing technique over the extracorporeal knotting one are useful for the significant reduce of tissue hypoxia and myometrium ischemia in the alteration area. Additionally, this technique is in favor of the physiological programmed suture absorption and the cell-mediated immunity, and associated with the lower risk of necrotic areas formation. In contrast to the intracorporeal continuous suturing technique, the tight and non-uniform extracorporeal knotting is associated with the suppression of staged elimination of blood microclots and other factors of aseptic inflammation in the surgical alteration area.

Conclusions. The use of extracorporeal knotting technique had no advantages over the intracorporeal continuous suturing, and, in the majority of cases, was associated with longer duration of procedure, inappropriate blood loss, as well as excessive consumption of suture material. The intracorporeal continuous suturing is the most optimal technique for uterine wound edges approximation, and associated with the positive outcomes regarding the reproductive function (the reproductive function could be realized in 3 months after the use of intracorporeal continuous suturing technique, in contrast to 6 months – after the extracorporeal knotting one), the minimal frequency of complications and favorable economic profile. The laparoscopic myomectomy in case of myoma sized 10 cm and more is associated with the risk of significant uterine wall defect and excessive blood loss, indicating the need for the intracorporeal continuous suturing technique for closing tissue defects in the area of surgical alteration of myometrium.