Comment: The quality of evidence is downgraded by study limitations (lack of blinding of outcome assessment in most of the studies).
A Cochrane review included 9 studies with a total of 808 subjects. Postoperative pain was measured on a visual analogue scale (VAS, 0-10), with zero meaning 'no pain at all'. Postoperative pain was significantly less, at 6 hours (MD -2.40, 95% CI -2.88 to -1.92; one study, n=148 women, moderate-quality evidence) and 48 hours postoperatively (MD -1.90, 95% CI -2.80 to -1.00; 2 trials, n=80 women, I² = 0%, moderate-quality evidence) in the laparoscopic myomectomy group compared with the open myomectomy group. No significant difference in postoperative pain score was noted between the groups at 24 hours. In-hospital adverse events: No evidence suggested a difference in unscheduled return to theatre (OR 3.04, 95% CI 0.12 to 75.86; 2 studies, n=188, I² = 0%, low-quality evidence) and laparoconversion (OR 1.11, 95% CI 0.44 to 2.83; 8 studies, n=756, I² = 53%, moderate-quality evidence) when open myomectomy was compared with laparoscopic myomectomy. Significantly lower risk of postoperative fever was observed in the laparoscopic group compared with groups treated with all types of open myomectomy (OR 0.44, 95% CI 0.26 to 0.77; 6 studies, n=635, I² = 0%). Shorter hospital stay was found with laparoscopic compared with all types of open myomectomy. No evidence suggested a difference in recurrence risk between laparoscopic and open myomectomy (RR 1.12, 95% CI 0.63 to 1.99; 4 trials, n=460, I² = 0%). The incidence of visceral injuries could not be estimated because of their low prevalence in this meta-analysis.
Date of latest search: 9 July 2014