Risk factors for uterine rupture after laparoscopic myomectomy.
Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether common causal factors could be identified. Published cases were identified via electronic searches of PubMed, Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3 cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No plausible contributing factor could be found in one case [corrected]. It seems reasonable for surgeons to adhere to techniques developed for abdominal myomectomy including limited use of electrosurgery and multilayered closure of the myometrium. Nevertheless, individual wound healing characteristics may predispose to uterine rupture.
Parker
William H
WH
John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California 90401-2831, USA. wparker@ucla.edu
Einarsson
Jon
J
Istre
Olav
O
Dubuisson
Jean-Bernard
JB
D004598:Electrosurgery / Q000009:adverse effects; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D011247:Pregnancy; D012307:Risk Factors; D013536:Suture Techniques / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000601:surgery*; D014597:Uterine Rupture / Q000209:etiology*; D014945:Wound Healing