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Limited Laparoscopic Myomectomy in Canada


 

LAS VEGAS — Only 25% of Canadian gynecologists perform laparoscopic myomectomy, and 71% cite lack of appropriate training as the main barrier to performing the procedure.

These are the key findings from the first survey to address current Canadian practice patterns regarding laparoscopic myomectomy, Dr. Rose Kung said at the annual meeting of the AAGL.

In a study led by her associate, Dr. Grace Liu of the department of obstetrics and gynecology at Sunnybrook Health Sciences Centre, Toronto, the researchers distributed surveys to 1,257 members of the Society of Obstetricians and Gynaecologists of Canada in April 2007. Of the 485 respondents who practice gynecology, 462 (95%) perform surgery, 444 (92%) perform laparoscopic surgery, and 385 (79%) perform abdominal myomectomies, yet only 119 (25%) perform laparoscopic myomectomies. Of these 119 respondents, only 15 (13%) use this approach for the majority of their cases.

The top three deterrents to performing laparoscopic myomectomy reported by the 119 respondents who use the procedure were the presence of an intramural fibroid (81%), a fibroid greater than 5 cm in size (54%), and more than three fibroids (54%), said Dr. Kung, also of the Sunnybrook Health Sciences Centre.

Among the 485 respondents overall, fewer than half of the respondents (44%) said that they have referred patients to another gynecologist for laparoscopic myomectomy. The most common reason for not referring was uncertainty as to who would be performing the procedure (33%); other reasons given by those surveyed included insufficient evidence to support the procedure (30%), a belief that the complication rate is higher with the procedure (21%), and a preference for operating on their own patients (18%).

When the respondents were asked to compare their perceptions of laparoscopic myomectomy with abdominal myomectomy, the majority indicated they believe that laparoscopic myomectomy confers a faster recovery time, less adhesion formation, and a comparable myoma recurrence rate. Most respondents were unsure about whether there were differences in outcome between the two procedures in terms of blood loss, postprocedure fertility rate, and uterine rupture risk.

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