5 - Laparoscopic managment of uterine myoma

Summary

The introduction of the laparoscopic approach for the management of intramural and subserosal uterine myomas has to a great extent revolutionized the modern management of myomas. Previously the only way to remove intramural and subserous myomas was by laparotomy, a procedure associated with significant postoperative morbidity. Therefore, physicians traditionally reserved abdominal myomectomy for a selected group of women where the risks and discomfort involved with laparotomy were judged worthy of the potential to preserve and enhance their fertility. Studies published in 1999 confirmed the advantages of laparoscopic myomectomy, such as the low morbidity and rapid recovery, which has led to the growing application of the technique towards women with symptomatic uterine myoma. However, laparoscopic operation is also associated with potential disadvantages including prolonged anesthesia, increased blood loss and possibly postoperative adhesion formation. This has led to a renewed interest in regard to the precise indications for performing laparoscopic myomectomy.

Indications

The primary reason for performing myomectomy in women of reproductive age is the preservation of the uterus for the purpose of childbearing. However, an increasing number of women currently elect to undergo laparoscopic removal of myomas, due to various symptoms associated with a rapidly growing or bulky uterus. In addition, some women resort to laparoscopic myomectomy when fibroids that are associated with heavy menstrual bleeding cannot be removed hysteroscopically.