Sesti Francesco, Pietropolli Adalgisa, Sesti Franz Federico, Piccione Emilio
Section of Gynecology and Obstetrics, Department of Surgical Sciences, School of Medicine, Tor Vergata University Hospital, Rome, Italy.
Minim Invasive Ther Allied Technol. 2013 Feb;22(1):1-8. doi: 10.3109/13645706.2012.680889. Epub 2012 May 4.
The aim of this review was to assess the role of gasless laparoscopy (GLM) in comparison with two other minimally invasive approaches to myomectomy, CO(2) laparoscopy (LM) and minilaparotomy (MM), focusing on the most recent randomized or prospective controlled studies.
A computerized search was made of the Medline, Science Citation Index, Current Contents, Embase, and PubMed databases for English language publications from the first reports of GLM, LM, and MM in 1995 to 2010. The fifteen most recent randomized or prospective controlled studies were selected and analyzed considering the operative and postoperative parameters.
One randomized controlled, one multicenter controlled, three prospective studies about GLM, four randomized controlled studies and one prospective study about LM, four randomized controlled trials and one prospective study about MM were reviewed and analyzed.
GLM offers some advantages eliminating the adverse effects and potential risks of CO(2) insufflation, particularly when large myomas have to be removed. The advantages of LM are the tamponade effect generated by the gas on the small vessels and the more precise myoma enucleation by using the endoscopic instruments, thus reducing intraoperative bleeding. MM can be a suitable option being associated with a lower overall level of surgical skill, even if it is desirable to have a standard universally accepted definition of "minilaparotomy" in order to correctly compare the results of the different studies. Lastly, the surgical outcomes of the three minimally invasive approaches to myomectomy are influenced by size, site, and number of the myomas, as well as by the skill and preference of the surgeon.All these criteria should be considered in the choice of the best minimally invasive approach to myomectomy.
本综述的目的是评估无气腹腹腔镜手术（GLM）与子宫肌瘤切除术的另外两种微创方法，即二氧化碳腹腔镜手术（LM）和小切口剖腹术（MM）相比的作用，重点关注最新的随机或前瞻性对照研究。
利用计算机检索Medline、科学引文索引、现刊目次、Embase和PubMed数据库，查找1995年至2010年关于GLM、LM和MM的首次报告以来的英文出版物。选择了15项最新的随机或前瞻性对照研究，并从手术和术后参数方面进行分析。
回顾并分析了一项关于GLM的随机对照研究、一项多中心对照研究、三项前瞻性研究，四项关于LM的随机对照研究和一项前瞻性研究，以及四项关于MM的随机对照试验和一项前瞻性研究。
GLM具有一些优势，可消除二氧化碳气腹的不良反应和潜在风险，特别是在必须切除大肌瘤时。LM的优势在于气体对小血管产生的压迫作用以及使用内镜器械更精确地切除肌瘤，从而减少术中出血。MM可能是一个合适的选择，因为其对手术技能的总体要求较低，不过为了正确比较不同研究的结果，需要有一个普遍接受的“小切口剖腹术”标准定义。最后，子宫肌瘤切除术的这三种微创方法的手术结果受肌瘤的大小、位置和数量以及外科医生的技能和偏好影响。在选择最佳的子宫肌瘤微创治疗方法时应考虑所有这些标准。
