Factors contributing to failure of laparoscopic myomectomy

Laparoscopic myomectomy is one of the best treatment options for women with symptomatic fibroids who wish to maintain their fertility. Compared with myomectomy by laparotomy, the laparoscopic approach is associated with shorter hospital stay, faster recovery, less postoperative pain, and reduced adhesion formation. Laparoscopic myomectomy is technically challenging, and occasionally the procedure needs to be completed by laparotomy. In this review, I will describe my team's experience with laparoscopic myomectomy and discuss factors contributing to failure. The most important factors affecting conversion of a laparoscopic myomectomy to laparotomy are patient selection and the laparoscopic expertise of the surgeon. Each surgeon should determine his or her criteria for laparoscopic myomectomy. Other factors include posterior intramural location, soft consistency associated with the use of gonadotropin releasing hormone agonist (GnRHa), the diameter of the dominant myoma, and the weight of the myoma. The use of robot-assisted technology may provide a means to overcome the challenges encountered with enucleation, extraction, and repair that are seen with conventional laparoscopic myomectomy.