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Laparoscopic myomectomy and myolysis
1Universités Gynécologue-Accoucheur des Hôpitaux, Hôpital Baudelocque, Paris, France.
Bailliere'S Clinical Obstetrics and Gynaecology
|December 1, 1995
Summary
Laparoscopic myomectomy is a viable surgical option for large uterine fibroids (5 cm and over), offering satisfactory outcomes. However, it requires experienced surgeons and has limitations for very large or multiple fibroids.
Area of Science:
- Minimally Invasive Surgery
- Gynecologic Oncology
- Surgical Techniques
Background:
- Operative laparoscopy offers advantages over traditional laparotomy.
- Laparoscopic myomectomy is an established surgical technique for uterine fibroid removal.
Purpose of the Study:
- To evaluate the efficacy and safety of laparoscopic myomectomy for large uterine fibroids (≥5 cm).
- To define the indications and limitations of laparoscopic myomectomy compared to laparotomy.
Main Methods:
- Description of laparoscopic myomectomy technique using a monopolar hook for uterine incision and endoscopic sutures.
- Myoma enucleation followed by layered uterine closure.
- Myoma removal via posterior colpotomy or suprapubic puncture site with an electrical cutting device.
Main Results:
- Satisfactory results in all 71 patients with fibroids ≥5 cm and over one year follow-up.
- Conversion to laparotomy in 2.7% of cases (two patients).
- No serious peri-operative or post-operative complications observed.
Conclusions:
- Laparoscopic myomectomy is feasible for large intramural fibroids (≥5 cm) when performed by experienced surgeons.
- Laparotomy is preferred for fibroids >10 cm or multiple myomectomies (>3).
- Further assessment of adhesion formation and uterine suture quality is needed.