title: Laparoscopic myomectomy focusing on the myoma pseudocapsule: technical and outcome reports.
abstract: BACKGROUND
  Our aim was to assess surgical complaints and reproductive outcomes of laparoscopic intracapsular myomectomies by a prospective observational study run in University affiliated hospitals.
  
  
  METHODS
  Between 2005 and 2010, 235 women underwent subserous and intramural laparoscopic myomectomy of fibroids (4-10 cm in diameter) for indications of pelvic pain, menstrual disorders, a large growing myoma or infertility. The main outcome measures were post-surgical parameters, including complications, the need for subsequent surgery or symptomatic relief, resumption of normal life and reproductive outcome.
  
  
  RESULTS
  Pelvic pain occurred in 27%, menorrhagia or metorrhagia in 21%, a large growing myoma in 10% and infertility in 42% of women. Single fibroids occurred in 51.9% of patients while 48.1% had multiple myomas. Of all patients, 58.2% had subserosal and 41.8% had intramural myomas. No laparoscopies were converted to laparotomy. In 3 years, 1.2% of patients had a second laparoscopic myomectomy for recurrent fibroids. The mean total operative laparoscopic time was 84 min (range 25-126 min), with mean blood loss of 118 ± 27.9 ml. By 48 h after surgery, 86.3% were discharged with no major post-operative complications. No late complications, such as bleeding, urinary tract infections or bowel lesions, occurred. Of the women who underwent myomectomy for infertility, 74% finally conceived. At term, 32.9% of patients underwent Caesarean section, 24.8% delivered by vacuum extractor and 42.2% had spontaneous deliveries. No case of uterine rupture occurred.
  
  
  CONCLUSIONS
  Intracapsular subserous and intramural myomectomy saving the fibroid pseudocapsule showed few early and no late surgical complications, enhanced healing by preserving myometrial integrity and allowed a good fertility rate and delivery outcome. In young patients suffering fibroids, laparoscopic intracapsular myomectomy is a potential recommended surgical treatment.
authors.affiliation: Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, P.zza Muratore, 73100 Lecce, Italy. andreatinelli@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Brad S
authors.initials: BS
authors.lastname: Hurst
authors.forename: Gernot
authors.initials: G
authors.lastname: Hudelist
authors.forename: Daniel Alberto
authors.initials: DA
authors.lastname: Tsin
authors.forename: Michael
authors.initials: M
authors.lastname: Stark
authors.forename: Liselotte
authors.initials: L
authors.lastname: Mettler
authors.forename: Marcello
authors.initials: M
authors.lastname: Guido
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007889:Leiomyoma / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D018231:Leiomyomatosis / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D009215:Myometrium / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D014597:Uterine Rupture / Q000517:prevention & control