title: Novel technique for total laparoscopic myomectomy: the "bottom-up suture".
abstract: BACKGROUND
  As more women with symptomatic uterine myomas undergo laparoscopic management without hysterectomy, we increasingly encounter many difficult situations, such as of the need to extract large intramural myomas. Even for a skilled surgeon, laparoscopic myomectomy in such a situation is difficult. We have established a new technique for laparoscopic myomectomy to solve these issues called the "bottom-up suture" method.
  
  
  METHODS
  Before complete removal of the myoma, countertraction is applied by an assistant with a claw forceps, elevating the bed of the myoma to make suturing easy. The deep myometrium can be sutured while the myoma is still attached to the uterus.
  
  
  CONCLUSIONS
  This technique, the "bottom-up suture," may improve the suturing of laparoscopic myomectomies. The advantages of this technique are that it is easy to control unexpected bleeding, and dead space formation can be prevented even when the myomas have grown deep into the uterine myometrium. This technique will become a reliable standard for laparoscopic myomectomy.
authors: Department of Gynecology and Obstetrics, Nara Medical University, Nara, Japan. ytana5172000@yahoo.co.jp
authors: Y
authors: Y
authors: Tanase
authors: K
authors: K
authors: Ikuma
authors: T
authors: T
authors: Matsumoto
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery*; D009215:Myometrium / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*