Background:

Uterine fibroids are among the leading causes of infertility in women of reproductive age. The optimal surgical approach for large FIGO type 0–2 fibroids remains controversial because it should ensure complete removal of the lesion while minimizing surgical trauma and preserving reproductive function.

Objective:

To compare surgical and reproductive outcomes following different organ-preserving surgical approaches in infertile women with large uterine fibroids and to identify the optimal surgical strategy.

Methods:

A retrospective comparative study included 160 infertile women with FIGO type 0–2 uterine fibroids measuring more than 5 cm. Patients were equally allocated into four groups according to the surgical approach: laparotomy, conventional laparoscopic myomectomy, laparoscopic myomectomy with temporary uterine artery occlusion, and hysteroscopic myomectomy. Surgical outcomes included operative time, intraoperative blood loss, hemoglobin decline, transfusion rate, hospital stay, postoperative complications, and repeat surgery. Reproductive outcomes included pregnancy rate and time to conception.

Results:

Laparoscopic myomectomy with temporary uterine artery occlusion demonstrated significantly lower intraoperative blood loss and postoperative hemoglobin decline compared with the other surgical techniques. No patients in this group required blood transfusion or repeat surgery. Hospitalization was significantly shorter following minimally invasive surgery than after laparotomy. Although cumulative pregnancy rates were comparable between groups, women treated laparoscopically achieved pregnancy earlier than those undergoing open surgery. These findings indicate that temporary uterine artery occlusion improves surgical safety without compromising reproductive outcomes. 

Conclusions:

Laparoscopic myomectomy with temporary uterine artery occlusion represents an effective organ-preserving approach for infertile women with large FIGO type 0–2 uterine fibroids. The technique minimizes surgical blood loss, reduces perioperative morbidity, shortens recovery, and preserves reproductive potential, supporting its broader implementation in reproductive gynecologic surgery.

To be Updated