Surgical management of neurovascular bundle in uterine fibroid pseudocapsule.
The uterine fibroid pseudocapsule is a fibro-neurovascular structure surrounding a leiomyoma, separating it from normal peripheral myometrium. The fibroid pseudocapsule is composed of a neurovascular network rich in neurofibers similar to the neurovascular bundle surrounding a prostate.  The nerve-sparing radical prostatectomy has several intriguing parallels to myomectomy. It may serve either as a useful model in modern fibroid surgical removal, or it may accelerate our understanding of the role of the fibrovascular bundle and neurotransmitters in the healing and restoration  of reproductive potential after intracapsular myomectomy. Surgical innovations, such as laparoscopic or robotic myomectomy applied to the intracapsular technique with magnification of the fibroid pseudocapsule surrounding a leiomyoma, originated from the radical prostatectomy method that highlighted  a careful dissection of the neurovascular bundle to preserve sexual functioning after prostatectomy. Gentle uterine leiomyoma detachment from the pseudocapsule neurovascular bundle has allowed a reduction in uterine bleeding and uterine musculature trauma with sparing of the pseudocapsule  neuropeptide fibers. This technique has had a favorable impact on functionality in reproduction and has improved fertility outcomes. Further research should determine the role of the myoma pseudocapsule neurovascular bundle in the formation, growth, and pathophysiological consequences of fibroids,  including pain, infertility, and reproductive outcomes.
Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com
Andrea
A
Tinelli
Antonio
A
Malvasi
Brad S
BS
Hurst
Daniel A
DA
Tsin
Fausto
F
Davila
Guillermo
G
Dominguez
Domenico
D
Dell'edera
Carlo
C
Cavallotti
Roberto
R
Negro
Sarah
S
Gustapane
Chris M
CM
Teigland
Liselotte
L
Mettler
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D009215:Myometrium / Q000294:innervation*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000000981:diagnostic imaging