Laparoscopic myomectomy: a review of alternatives, techniques and controversies (original) (raw)
Related papers
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 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 – The importance of surgical techniques
Frontiers in Medicine, 2023
Laparoscopy is a routine procedure for benign gynecological tumors. Although the laparoscopic approach for myomas is a common procedure, it can be challenging. To improve outcomes, research regarding port access, suture type, morcellation, and complication management remains ongoing. Myomectomy is the main surgical option for patients seeking uterus-sparing procedures to maintain future fertility. The laparoscopic technique is the most important in these cases, given that possible complications can impact fertility and pregnancy outcomes. Herein, we reviewed and collated the available data regarding different suture techniques, including advantages, difficulties, and possible long-term impacts.
The role of laparoscopic-assisted myomectomy (LAM)
JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
Laparoscopic myomectomy has recently gained wide acceptance. However, this procedure remains technically highly demanding and concerns have been raised regarding the prolonged time of anesthesia, increased blood loss, and possibly a higher risk of postoperative adhesion formation. Laparoscopic-assisted myomectomy (LAM) is advocated as a technique that may lessen these concerns regarding laparoscopic myomectomy while retaining the benefits of laparoscopic surgery, namely, short hospital stay, lower costs, and rapid recovery. By decreasing the technical demands, and thereby the operative time, LAM may be more widely offered to patients. In carefully selected cases, LAM is a safe and efficient alternative to both laparoscopic myomectomy and myomectomy by laparotomy. These cases include patients with numerous large or deep intramural myomas. LAM allows easier repair of the uterus and rapid morcellation of the myomas. In women who desire a future pregnancy, LAM may be a better approach b...
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...
Acta Medica Transilvanica
Pelvic masses are commonly diagnosed following clinical examination. These may be located in the genital organs or may interest other pelvic and abdominal organs. The pathology of the pelvic masses varies with age. The postmenopausal period is most commonly associated with malignant pathology while reproductive age is associated with benign pathology. The purpose of this paper is to present the experience of the Obstetrics and Gynaecology Clinic of the Sibiu County Clinical Emergency Hospital in laparoscopic myomectomy. We evaluated the patients admitted to the Obstetrics and Gynaecology Clinic of the Emergency County Clinical Hospital in Sibiu who underwent a laparoscopic myomectomy between 1.01.2015 - 06.06.2019. During this time, 14 laparoscopic myomectomies were performed in our clinic. Patients ranged in age from 29 to 57 years.
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...
Journal of minimally invasive gynecology, 2015
There is concern that morcellation of occult leiomyosarcomas during surgery to treat presumed myomas may substantially worsen patient outcome. We reviewed the existing medical literature to better understand whether such a risk was demonstrable and, if so, what the magnitude of that risk might be. We identified 4864 articles initially, of which 60 were evaluated in full. Seventeen were found to have outcomes information and are included in this review. Six studies addressed the question of whether morcellation of occult leiomyosarcomas resulted in inferior outcomes as compared with en bloc uterine and tumor removal. In these 6 studies, results suggested that en bloc removal may result in improved survival and less recurrence; however, the data are highly biased and of poor quality. There is no reliable evidence that morcellation, power or otherwise, substantially results in tumor upstaging. There is no evidence from these 17 studies that power morcellation differs in any way from other types of morcellation or even simple myomectomy insofar as patient outcome. Whether electromechanical morcellation poses a unique danger to the patient with occult leiomyosarcoma is an unanswered question and one clearly in need of more extensive investigation before conclusions are drawn and policies created. Journal of Minimally Invasive Gynecology (2015) 22, 26-33 Ó 2015 AAGL. All rights reserved.
Review of Laparoscopic Myomectomy Versus Open Myomectomy
IOSR Journals , 2019
Introduction: Uterine fibroid are the commonest benign tumor found in women of reproductive age group. Mostly asymptomatic but some times it causes symptoms like abnormal menstrual bleeding, pelvic pain, pressure symptoms, subfertility. Treatment available for fibroid are medical therapy, UAE, MRI guided focused ultrasonography thermal therapy, myomectomy, hysterectomy. Myomectomy is the preferred option for women who wish to retain their reproductive function, although hysterectomy is the most definitive treatment for symptomatic fibroid, when there is no valid reason for myomectomy. Study Design: Retrospective analytical review, where searches where conducted in Pubmed, Medline, Springer, Cochrane Library to identify relevant literature. Aim and objective: The purpose of this study is to determine the better surgical method for myomectomy by comparing laparoscopic and open myomectomy with regards to surgical outcomes such as intraoperative blood loss, duration of surgery, hospital stay and intra and peri-operative complications. Conclusion: Compared to open myomectomy, laparoscopic myomectomy has added advantages such as early recovery, less post-operative pain, less duration of hospital stay, reduced intra-operative blood los, less adhesion formation. Recurrence and pregnancy rates after myomectomy are similar after both the surgeries. Despite laparoscopic myomectomy having many advantages open myomectomy is still a frequently performed procedure. Due to advantages of laparoscopic surgery, efforts have to be made to implement this procedure into daily practices by training more surgeons in this field so as to provide best care to the patients.