Laparoscopic Myomectomy.
Laparoscopic myomectomy (LM) is an increasingly accepted method of treatment for symptomatic uterine leiomyomas. It affords patients a minimally invasive surgery compared to the more traditional abdominal approach. Studies have shown the benefits of decreased blood loss, shorter hospital stay and recovery period, as well as decreased postoperative pain and fever in comparison to abdominal myomectomy (AM). Even myomas larger than 5 cm can be laparoscopically resected safely in the hands of an experienced surgeon. To date, studies indicate a decreased adhesion rate with the laparoscopic approach compared to the abdominal procedure. The use of adhesion barriers may decrease this rate further. In infertile women with myomas, pregnancy and live-birth rates improve following LM, and appear to be comparable with those rates achieved following AM. The data regarding the risk of uterine rupture in pregnancy following LM is limited. However, small studies show safe outcomes when patients are managed with the same degree of caution one might employ with post-abdominal myomectomy patients. In performing LM, a precise and diligent technique should be exercised to ensure a secure, multilayer closure.
Peacock
Kelly
K
Women's and Children's Hospital, North Adelaide, SA, Australia.
Hurst
Bradley S
BS
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013526:Surgical Mesh; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*