Laparoscopic myomectomy for fibroids penetrating the uterine cavity: is it a safe procedure?

Abstract

Objective The purpose of the study was to evaluate the post-operative course and follow up of women who had undergone laparoscopic removal of intramural fibroids penetrating the uterine cavity. Design Retrospective study.Setting Center for Reconstructive Pelvic Endosurgery, Italy.Population Thirty-four women with fibroids penetrating the uterine cavity. Methods Laparoscopic myomectomy.Main outcome measures Feasibility and safety of surgical technique, length of operation, blood loss, intraor post-operative complications, length of hospital stay, resolution of symptoms and future obstetric outcome. Results The mean operative time was 79 (SD 30) minutes; the mean reduction in haemoglobin was 1.1 F 0.9 g/dL. No intra-or post-operative complications were observed. The average post-operative stay in hospital was 54 (SD 22) hours. Nineteen (73%) out of 26 patients who had experienced symptoms prior to surgery reported resolution of these symptoms post-operatively. All patients resumed work within a mean time of 20 (SD 8) days. Among 23 of the 32 patients attempting pregnancy during the follow up period, nine (39%) conceived within one year. Seven pregnancies went to term without complications. Conclusion The clinical results of this study suggest that laparoscopic myomectomy for intramural fibroids penetrating the uterine cavity is a safe procedure, providing well known advantages of minimal access surgery.

Parallel hysteroscopic and laparoscopic myomectomy in infertile patients

“…Should the cave open even so, it is advisable to close the myoma bed in two layers and provide antibiotic treatment in the postoperative period. This circumstance does not affect the time of hospitalisation [7].…”

Ultra-Minilaparotomy Myomectomy: A Minimally Invasive Surgical Approach for the Treatment of Large Uterine Myomas

“…Less important seems to be the risk of recurrent leiomyomas after laparoscopy. Previous studies have shown a higher risk of recurrence after laparoscopic myomectomy than after a traditional myomectomy, with a 33% recurrence risk at 27 months [21] ; however, more recent randomized clinical trials showed no significant difference [25,26] . The number of myomas and their size and location into the uterine wall are probably the most important risk factors for recurrence, whereas the surgical route most likely does not play a major role.…”

Laparoscopic myomectomy of a large pedunculated fibroid: case report

“…seracchioli et al (13) in their evaluation on laparoscopic myomectomy reported that the feasibility of laparoscopic myomectomy has definitely been demonstrated. Although no definitive criteria have been established, deep intramural fibroids reaching the uterine cavity may represent a contraindication to laparoscopic myomectomy, due to intraoperative bleeding and inadequate closure of the myometrium.…”

“…some of the main concerns regarding laparoscopic myomectomy have been adequate reconstruction and healing of the uterine wall defect following myomectomy, and the possible resulting obstetric complications, including ability of the uterus to withstand pregnancy and labour, and high incidence of elective caesarean section (12). Many of the previous cases of uterine rupture in pregnant women following laparoscopic myomectomy occurred during second and third trimesters (28-36 weeks) (12,13). seracchioli et al advocated adequate tissue approximation, prevention of haematoma formation and limited use of electro coagulation as pointers towards a successful laparoscopic procedure (13).…”

“…Many of the previous cases of uterine rupture in pregnant women following laparoscopic myomectomy occurred during second and third trimesters (28-36 weeks) (12,13). seracchioli et al advocated adequate tissue approximation, prevention of haematoma formation and limited use of electro coagulation as pointers towards a successful laparoscopic procedure (13). the patient presented was a 37 year old single female with no current desire of fertility.…”