title: Uncertainties about laparoscopic myomectomy during pregnancy: A lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case.
abstract: OBJECTIVE
  The aim of this report was to perform a critical review of the literature about feasibility, safety, limitations and contraindications of laparoscopic myomectomy during pregnancy starting from a peculiar case of a 15-weeks pregnant woman affected by a symptomatic large myoma.
  
  
  METHODS
  A 35 year-old Caucasian-nulliparous-woman was referred to our unit at nine weeks of gestation for abdominal heaviness and constipation. The ultrasound examination revealed the presence of a 24 cm pedunculated myoma. The initial management was conservative until the achievement of 15 gestational weeks, when the worsening of abdominal pain led to the need of a laparoscopic myomectomy. Intraoperative blood-loss was 600 ml and operating-time was 150 minutes (70 minutes were required for the morcellement); the postoperative course was normal. The pregnancy evolved regularly and, at 41 weeks, the patient delivered by urgent caesarean section (because intrapartum fetal heart rate abnormalities) a healthy male baby weighing 4460 gr. Both post-partum and puerperium period had a regular course.
  
  
  CONCLUSIONS
  Laparoscopic myomectomy is feasible and safe during pregnancy for both mother and fetus and vaginal delivery should not be contraindicated. Evidence from our and other reported cases suggests that, during pregnancy, laparoscopic myomectomy should be considered the best surgical choice when subserous peduncolated myomas are symptomatic.
authors.affiliation: Department of Woman and Child Health, University of Padua , Padua , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Silvia
authors.initials: S
authors.lastname: Visentin
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.forename: Erich
authors.initials: E
authors.lastname: Cosmi
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
mesh_terms: D000328:Adult; D002585:Cesarean Section; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*
keywords: Laparoscopic myomectomy; evidence-based guidelines; maternal-fetal wellbeing; myoma complicated pregnancy; procedure safety; surgical approach