Surgical Management of Leiomyomas for Fertility or Uterine Preservation

Abstract

Leiomyomas are the most common pelvic tumors in women. These tumors are not always symptomatic but can cause abnormal uterine bleeding and anemia, pelvic pressure and pain, urinary frequency, and adverse reproductive outcomes-symptoms that can diminish the quality of life of women. Myomectomy is the primary treatment modality for women with symptomatic leiomyomas who are of reproductive age and desire future fertility. Myomectomy can significantly improve symptoms and quality of life and, in some clinical situations, improve reproductive outcomes. There are robust surgical outcome data supporting the use of a minimally invasive approach such as laparoscopy and hysteroscopy over laparotomy. Perioperative outcomes and return to normal activity are significantly better with a minimally invasive approach. Reproductive outcomes are not adversely affected. Detailed preoperative imaging is required for minimally invasive procedures to be successful. There are several evidence-based techniques that can be used to reduce blood loss during surgery. The role of robotic technology in enhancing surgical outcomes has not been clearly defined.

Reproductive outcomes following robotic myomectomy

“…17 Furthermore, RALM may avoid complications associated with myomectomy performed by laparotomy, including postoperative hemorrhage, ileus, bowel obstruction, cystotomy, and pelvic abscess formation. 5 RALM has been shown to be associated with longer duration of surgery, ranging from 174.6 to 181 minutes in prior studies. 31,39 Increased operative time is a major contributing factor to the increased cost of RALM.…”

“…[1][2][3][4] Symptomatic fibroids serve as the most common indication of the approximately 540,000 hysterectomies performed annually in the United States. 5 However, in reproductive-aged women who desire uterine conservation and fertility, myomectomy is the treatment of choice. 5 Fibroids are estimated to be present in 5-10% of women with subfertility and may act as the primary cause of infertility in 2-3% of cases.…”

“…5 However, in reproductive-aged women who desire uterine conservation and fertility, myomectomy is the treatment of choice. 5 Fibroids are estimated to be present in 5-10% of women with subfertility and may act as the primary cause of infertility in 2-3% of cases. 3,6,7 Fibroids are hypothesized to interfere with normal reproductive tract function and fertility via various mechanisms.…”

“…[8][9][10] In cases where fibroids are intramural and do not distort the uterine cavity, published studies report inconsistent findings. 5,8,[11][12][13][14][15] A systematic review by Falcone et al demonstrated that the presence of intramural fibroids reduced implantation, clinical pregnancy and live birth rates in a cohort of women with normal uterine cavities on hysterosalpingogram or saline sonogram. isolated causal factors, surgical treatment of uterine fibroids may be indicated.…”

Postoperative pain after total abdominal hysterectomy and bilateral salpingo-oophorectomy depending on the type of anaesthesia administration

“…There are two surgical procedures available: a more conservative one À myomectomy and a radical one À total or subtotal hysterectomy. [1] Total abdominal hysterectomy and bilateral salpingooophorectomy is the procedure in which the doctor removes the uterus, including the cervix, both ovaries and fallopian tubes. The fast recovery depends on minimizing the postoperative symptoms, especially pain.…”