Exploring Surgical Strategies for Uterine Fibroid Treatment: A Comprehensive Review of Literature on Open and Minimally Invasive Approaches

Abstract

Background and Objectives: Uterine myomas represent one of the most prevalent pathologies affecting the female population. These benign neoplasms originate from the smooth muscular cells of the uterus, and they can be either single or multiple. Often associated with debilitating symptoms such as pelvic heaviness, pain, constipation, and urinary dysfunctions, the surgical management of myomectomy exhibits considerable variability. This diversity in approaches is influenced by factors such as the number and size of myomas, the patient’s age, and overall clinical conditions. This study aims to elucidate and compare the advantages and disadvantages of different surgical approaches, specifically endoscopic procedures versus open surgery, providing valuable insights for clinical decision making. Materials and Methods: A comprehensive bibliographic search spanning from 2013 to 2023 was systematically conducted across databases including Medline, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. The search utilized keywords such as “myomectomy laparoscopic and open”, “myomectomy open and minimally invasive”, “myomectomy open and laparoscopic”, and “myomectomy open vs. laparoscopic.” The research methodology, along with predetermined inclusion and exclusion criteria, was established prior to the search, ensuring a systematic and rigorous approach. Subsequently, data analysis was carried out. Results: Following the study selection process, 25 articles met the eligibility criteria for inclusion in this analysis. The average numbers of myomas were 3.7 (ranging from 1 to 13.7) and 5.4 (ranging from 1 to 13.5) for the minimally invasive surgery and open surgery groups, respectively. In terms of myoma size, the total averages across studies were 7 cm (ranging from 4.8 to 14) for the minimally invasive group and 8 cm (ranging from 3.9 to 11.2) for the open surgery group. The average pregnancy and delivery rates were 29.7% (ranging from 1.8 to 100) for the minimally invasive group and 28.5% (ranging from 1.8 to 100) for the open surgery group. Regarding complications, the average rate was 14.2% (ranging from 0 to 50) for the endoscopic group and 22.3% (ranging from 0 to 60.3) for the laparotomic group. Conclusions: In conclusion, a critical factor influencing the choice of surgical approach is primarily the size and quantity of fibroids. The mini-laparotomic approach emerges as a viable alternative to endoscopy, demonstrating favorable surgical outcomes and aesthetic results. Interestingly, the type of surgical procedure appears to have no significant impact on the pregnancy rate.

Cesarean Myomectomy: Reflections on Clinical and Surgical Controversies between a New Trans-Decidual Technique vs. Traditional Method

“…Since the advent of myomectomy in clinical practice, the conventional wisdom in myoma surgery has been to perform a SM wherever possible without entering the uterus. That was the situation prior to the development of hysteroscopic surgery, which gained popularity as a treatment for fibroids with a minimum volume of 50% that protruded into the uterine cavity and were pedunculated or submucosal [11], until the hysteroscopic approach was suggested in some cases for fibroids that made up less than half of the entire volume of the uterine cavity [12]. For many years, CM was carried out in the same way: most fibroids were removed by dissection through the uterine serosa as a SM (Figure 1), while pedunculated submucosal myomas were removed by clamping, cutting, and suturing the pedicle in the uterine cavity.…”

“…the uterine cavity and were pedunculated or submucosal [11], until the hysteroscopic approach was suggested in some cases for fibroids that made up less than half of the entire volume of the uterine cavity [12]. For many years, CM was carried out in the same way: most fibroids were removed by dissection through the uterine serosa as a SM (Figure 1), while pedunculated submucosal myomas were removed by clamping, cutting, and suturing the pedicle in the uterine cavity.…”

Courses of pregnancy in women witha uterine scar after conservative myomectomy

“…Тактика ведения и лечения пациентов с миомой матки в первую очередь зависит от локализации, размеров узла, темпа и характера роста миоматозных узлов, а также от возраста пациентки и состояния ее репродуктивной системы. Существует множество способов консервативного лечения миомы матки, однако основным методов лечения все же остается хирургический [7,8].…”

Minimizing Blood Loss in Laparotomic Myomectomy through the Tourniquet Use: Insights from Our Clinical Experience and Literature Review

“…The surgical methods for myomectomy are diverse, encompassing a variety of approaches such as hysteroscopic, laparoscopic (inclusive of robot-assisted techniques), and traditional laparotomy to ensure the effective removal of fibroids. The surgical plane is carefully made based on the distinctive features of the leiomyomas, such as size, quantity, and anatomical site [3,4]. The laparoscopic modality, whenever feasible, is considered the gold standard, heralded for its association with reduced blood loss, diminished morbidity rates, expedited hospital discharge times, and alleviated postoperative discomfort in comparison to conventional open myomectomies [5].…”