Endoscopic management of uterine fibroids

Uterine fibroids are very common, but their relationship to fertility is still controversial. Data in relation to fibroids and fertility mainly come from retrospective case series and prospective uncontrolled trials. Although some authors advocate prospective controlled studies, it is unlikely that an easy answer will be found due to considerable variations in location, size and number of fibroids, presence of additional infertility factors and variation of surgical techniques. Submucosal fibroids are more likely to be associated with menstrual disorders and subfertility, and hysteroscopic myomectomy has been accepted as the standard treatment for them. Treatment of submucosal fibroids may be associated with better reproductive outcomes. There is bigger controversy over the impact of intramural and subserosal fibroids on fertility. Laparoscopic myomectomy is now used by a large number of groups for removal of these fibroids in selected cases, but still remains a challenging procedure which requires advanced laparoscopic skills. Its advantages over open myomectomy include reduced postoperative pain, shorter hospitalization, quicker recovery, reduced febrile morbidity and blood loss. It may also reduce the risk of postoperative adhesion formation. There are now large numbers of pregnancies following laparoscopic myomectomy and the risk of uterine rupture in future pregnancies seems to be very low with good surgical technique.