The complication rate appears to be better than acceptable in comparison with complication rates reported after laparotomic myomectomies. This is one of the largest series reported of laparoscopic myomectomy and the first focused on complications. Odds ratio computed to estimate the risk of complications in relation to the patient characteristics showed that the probability of complications significantly rises with an increase in the number (more than 3 myomas OR: 4.46, p <.001) and with the intramural (OR: 1.48, p <.05) or the intraligamentous location of myomas (OR: 2.36, p <.01) whereas the myoma size seems to influence particularly the risk of major complications (OR: 6.88, p <.001). After a follow-up period of 41.70 +/- 23.03 months (mean +/- SD), 386 (22.9%) patients conceived, with a pregnancy rate in patients wishing pregnancy of 69.8% among them, 1 (0.26%) recorded spontaneous uterine rupture at 33 weeks gestation. Two patients were readmitted for surgery (0.09%): 1 had a laparoscopic hysterectomy because of a severe blood loss, and the other had drainage of a hematoma in the broad ligament. Failure to complete planned surgery occurred in 7 cases (0.34%). The most serious events were hemorrhages (14 cases, 0.68%) requiring blood transfusions in 3 cases (0.14%) 10 postoperative hematomas (0.48%, one in the broad ligament and 9 in the myomectomy scar) 1 bowel injury (0.04%) 1 postoperative acute kidney failure (0.04%) and 2 unexpected sarcomas (0.09%). Minor complications accounted for 9.1% (187/2050 cases) and major complications for 2.02% (38/2050 cases). Total complication rate was 11.1% (225/2050 cases). Myomas smaller than 4 cm were removed during myomectomy for larger ones. Myoma size ranged from 1 to 20 cm (mean 6.40 +/- 2.6 SD). Most patients (48%) had more than 1 myoma, with a maximum of 15 per patient (myomas removed for patients: 2.26 +/- 1.8, mean +/- SD). Single or multiple myomectomies (n = 2050) for symptomatic myomas measuring at least 4 cm in diameter were performed. The serosa was always incised in a vertical fashion mechanical enucleation of the myoma was completed whenever possible suture was performed in 1 or 2 layers with deep and large stitches swaged to 1 or 0 polyglactin sutures that were tied intracorporeally or extracorporeally. Injection of vasoconstrictive agents was used in 37%. The surgical technique, as well as the expertise of the operators, was the same for the 4 centers. The incidence and type of complications occurring in 2050 laparoscopic myomectomies undertaken from January 1998 through December 2004 were recorded. Prospective study, with a review of the patient records by the first author (Canadian Task Force classification II-2). To study intraoperative and postoperative complications of laparoscopic myomectomy and patients' characteristics influencing this risk.
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