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.