Tips for Safe Laparoscopic Multiple Myomectomy

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Reproductive Medicine
• Surgical Oncology

Background:

• Uterine fibroids (myomas) affect a significant portion of women, often causing symptoms like heavy bleeding and infertility.
• Traditional treatments include open surgery or less invasive methods, but challenges remain for multiple or large fibroids.

Observation:

• A case presentation of a 27-year-old woman with symptomatic multiple uterine fibroids (7 fibroids, 3-10 cm) requiring surgical intervention.
• Detailed description of a stepwise laparoscopic multiple myomectomy technique, including port placement, vasopressin use, myomectomy technique, suturing, and in-bag morcellation.

Findings:

• Key surgical steps demonstrated include specific port positioning, intermittent vasopressin administration, cold myomectomy technique, myoma lace and garland creation for retrieval, and in-bag morcellation.
• The technique effectively reduces blood loss (vasopressin) and operative time (barbed sutures), while preventing fibroid dissemination and visceral injury (in-bag morcellation).

Implications:

• This laparoscopic approach offers potential benefits for managing multiple uterine fibroids, provided it is performed by experienced surgical teams.
• The described techniques enhance safety and efficiency in laparoscopic multiple myomectomy, potentially improving patient outcomes.