Laparoscopic Myomectomy: Technique, Complications, and Ultrasound Scan Evaluations (original) (raw)

Laparoscopic myomectomy: a current view

Human Reproduction Update, 2000

Since 1990 laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from the literature, the authors report on the situation today regarding the operative technique for LM and the risks and bene®ts of the technique as compared with myomectomy by laparotomy. The operative technique comprises four main phases: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. LM offers the possibility of a minimally invasive approach to treat medium-sized (<9 cm) subserous and intramural myomata by surgery when there are only two or three of them. When conducted by experienced surgeons, the risk of peri-operative complications is no higher using this technique. Use of the laparoscopic route could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of post-operative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. The risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy.

Laparoscopic Myomectomy: Clinical Outcomes and Comparative Evidence

Journal of Minimally Invasive Gynecology, 2015

Laparoscopic myomectomy is a common surgical treatment for symptomatic uterine leiomyomas. Proponents of the laparoscopic approach to myomectomy propose that the advantages include shorter length of hospital stay and recovery time. Others suggest longer operative time, greater blood loss, increased risk of recurrence, risk of uterine rupture in future pregnancies, and potential dissemination of cells with use of morcellation. This review outlines techniques for performance of laparoscopic myomectomy and critically appraises the available evidence for operative data, short-term and long-term complications, and reproductive outcomes.

Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients

Journal of minimally invasive gynecology

To review surgical outcomes and histopathological findings after laparoscopic myomectomy by a team at a university teaching hospital. This was a retrospective review of consecutive cases of laparoscopic myomectomy performed by members of our minimal access surgery team between January 2004 and December 2015 (Canadian Task Force classification II-3). A university teaching hospital. Women undergoing laparoscopic myomectomy. Laparoscopic myomectomy. We collected women's demographic data, clinical histories, and surgical outcomes, including complication rates and the incidence of undiagnosed uterine malignancy. Five hundred fourteen women were booked for laparoscopic myomectomy during the study period. Five hundred twelve of 514 (99.6%; 95% confidence interval [CI], 99.05-100.00) procedures were successfully completed. Two cases were converted to open surgery: one because of suspected uterine malignancy and another because of bowel injury at initial entry. The median number of myoma...

Complications of laparoscopic myomectomy: A single surgeon’s series of 1001 cases

Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010

The objective of this retrospective study was to evaluate the safety, intra-operative and post-operative morbidity of laparoscopic approach for myomectomy. Methods: The total 1001 subjects who underwent endoscopic surgery over a 16-year period were studied retrospectively. All the data were collected regarding clinical presentation, intra-operative findings, intra-operative and post-operative complications, and hospital stay, and statistically analysed. Results: The average age of subjects was 32.62 years and the most common indication for surgery was infertility (48.5%). A total of 2167 myomas were removed; 43.98% of subjects required removal of multiple myomas. The average blood loss was 248 mL, and the average hospital stay was 1.5 days. The overall major and minor complication rate is very low except one subject who required laparotomy for post-operative bleeding, and there was one unexplained postoperative death. Conclusions: Laparoscopic myomectomy is comparable to laparotomy myomectomy in terms of duration of surgery, blood loss and complication rates. This large single surgeon series on laparoscopic myomectomy also shows a low complication rate suggesting that laparoscopic myomectomy is a safe and reliable procedure, even in the presence of multiple or large myomas.

Uterine Rupture after Laparoscopic Myomectomy in Two Cases: Real Complication or Malpractice?

Case Reports in Obstetrics and Gynecology, 2017

We describe two cases of uterine rupture in pregnancy after laparoscopic myomectomy and analyze all the aetiological factors involved in this circumstance according to the recent literature, focusing above all on the surgical procedures and the characteristics of the excised myomas. The two cases of uterine rupture in pregnancy following laparoscopic myomectomy occurred at 36 and 18 weeks of gestation, respectively. Both women had undergone laparoscopic multiple myomectomy and uterine rupture occurred along the isthmic myomectomy scars, despite the fact that compliance with all the recent technical surgical recommendations for the previous laparoscopic multiple myomectomy had been fully observed. In our cases we identified the isthmic localization, size of the excised myomas (≥4 cm), and individual characteristics of the healing process as possible risk factors for "a real complication." Larger studies and robust case-control analyses are needed to draw reliable conclusions; special care should be paid when performing laparoscopic myomectomy in women planning a later pregnancy.

Pregnancy Outcomes and Deliveries after Laparoscopic Myomectomy

The Journal of the American Association of Gynecologic Laparoscopists, 2003

In the view of its benefits and low risk of complications, 1-3 laparoscopic myomectomy (LM) is an effective alternative to laparotomic myomectomy, although it is technically demanding even for skilled laparoscopists. Four case reports of spontaneous uterine rupture 4-7 during pregnancy in women conceiving after LM raise questions concerning the safety of this technique, specifically, the adequacy of laparoscopic suturing of myometrium in patients who desire future pregnancy. To date there are few significant data about pregnancy outcomes and deliveries after LM. Only two published series 8,9 had study populations of more than 65 pregnancies, with 57 and 100 deliveries, respectively. Materials and Methods Institutional review board permission was not considered necessary as treatment and study end points were similar to our usual clinical practice. We assessed pregnancy outcomes and deliveries in 359 patients who underwent LM, with removal of 768 myomas. Main indications for surgery were pelvic mass, abnormal uterine bleeding, pelvic pain, and infertility. 3 A detailed description of our surgical technique is available elsewhere. 3 Briefly, three suprapubic access ports were employed. Dilute Ornitine-8-vasopressin (POR 8; Sandoz, Berne, Swit-zerland) was injected into several sites, followed by a longitudinal incision of the most distended part of myometrium down to the pseudocapsule with unipolar hook or scissors. After the cleavage plane was identified, the myoma was enucleated by means of adequate traction with a myoma drill and countertraction with a strong grasper and suctionirrigator. Laparoscopic closure of the myometrial wound was performed in one, two, or, exceptionally, three layers depending on the depth of the myoma. Interrupted sutures of braided-coated polyglycolic acid 0 or 2/0 were primarily used. Hemostasis was fundamentally achieved with endoscopic suturing, with bipolar coagulation used only for significant bleeders. No adhesion-prevention mechanism was employed. Antibiotics were given prophylactically just before surgery and postoperatively every time the uterine cavity was opened. Patients were discharged on postoperative day 2, after two-dimensional endovaginal sonographic assessment of the uterine scar. A waiting period of 6 to 8 months before attempting to conceive was recommended depending on the surgeon's assessment of uterine wound healing. No particular recommendations were made concerning type of delivery after LM. Follow-up ranged from 25 to 41 months (average 35 mo). Using telephone questionnaire, we collected the following data for each woman: one or more pregnancies since surgery, time between myomectomy and conception, 177

Developments in techniques for laparoscopic myomectomy

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

Conflicting opinions about laparoscopic myomectomy (LM) are still present regarding indications and risks related to reproductive outcome. We reviewed our 13-year experience (1) to identify risk factors or changes in methods that have improved our myomectomy technique and (2) to evaluate how the learning curve and improved surgical devices influenced our procedures, and (3) to study the myomectomy scar with a power color Doppler ultrasound (US). From January 1991 to December 2003, we studied 332 patients who underwent laparoscopic myomectomy. We analyzed, as the learning curve, how the introduction of the Steiner morcellator, the use of vasoconstrictive agents, and different techniques of suturing have influenced parameters such as operating time and blood loss. We performed 332 single or multiple myomectomies for symptomatic myomas. Most patients (47%) had more than one myoma, with a maximum of 8 per patient (average myomas removed for patients: 2.23, range 1 to 8). Myoma size rang...