Laparoscopic myomectomy: a review of alternatives, techniques and controversies

Abstract

Key content Laparoscopic myomectomy (LM) is considered to be particularly technically difficult because it requires advanced intracorporeal suturing. LM involves a wide continuum of surgical difficulty; surgeons must be self‐aware of both their skill‐set and their limitations when selecting appropriate patients for this surgery. The greater a woman's age, the less there is to be gained by preserving her future fertility and the greater the risk of leiomyosarcoma. Hysterectomy should be considered when fertility is no longer desired or feasible. When asking a patient to give consent for LM, the following risks must be mentioned: parasitic myomata and disseminated peritoneal leiomyomatosis, and potentially upstaging an occult malignancy (such as leiomyosarcoma). There is currently no preoperative test to definitively exclude leiomyosarcoma. Learning objectives To understand the importance of thorough preoperative counselling before LM, including the potential risks of intracorporeal morcellation. To understand the key steps involved in performing an LM. Ethical issues The potential benefits of a laparoscopic versus open myomectomy must be considered; for example, does the worsened prognosis in women with unsuspected leiomyosarcoma, inadvertently morcellated, outweigh adverse outcomes in patients who undergo open myomectomy? Since in‐bag morcellation remains an experimental technique, its possible benefits and long‐term outcomes are yet to be established.

Review of advanced energy devices for the minimal access gynaecologist

“…UDs are versatile instruments suitable for a variety of procedures, including total laparoscopic hysterectomy and adnexal surgery. However, UDs are particularly favourable for cases requiring complex dissection, such as excision of deeply infiltrating endometriosis, ureterolysis and laparoscopic myomectomy 12 …”

“…Its inherent versatility means Thunderbeat can be used for a variety of surgical procedures. However, it conveys greatest advantage when applied in advanced laparoscopic surgery, such as that encountered in gynaeoncology, performing excision of severe endometriosis or laparoscopic myomectomy 12 …”

Authors’ reply

“…We would like to thank Maden et al for their interest in our review of laparoscopic myomectomy alternatives, techniques and controversies. An interesting point is made regarding a possible link between laparoscopic myomectomy and subsequent uterine rupture.…”

Re: Laparoscopic myomectomy: a review of alternatives, techniques and controversies

“…We thank Bryant‐Smith and Holland for their very thorough review article pertaining to alternatives, techniques and controversies surrounding laparoscopic myomectomy . We would like to share our experience of an unusual case of recurrent spontaneous prelabour uterine fundal rupture that occurred following laparoscopic myomectomy.…”