Human Reproduction Update, Vol.6, No.6 pp.588-594, 2000
© European Society of Human Reproduction and Embryology 2000; all rights reserved
Laparoscopic myomectomy: a current view
1 Service de chirurgie gynécologique, Clinique universitaire Baudelocque, CHU Cochin – Saint Vincent de Paul, 123 Bd Port-Royal, 75014 Paris, France
To whom correspondence should be addressed at: Jean-Bernard Dubuisson, Service de chirurgie gynécologique, Clinique universitaire Baudelocque, CHU Cochin Port-Royal, 123 Bd Port-Royal, 75014 Paris, France. Tel: 33 1 42 34 12 13; Fax. 33 1 40 51 77 62
Abstract
Since 1990 laparoscopic myomectomy (LM) has provided an alternative to laparotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from the literature, the authors report on the situation today regarding the operative technique for LM and the risks and benefits of the technique as compared with myomectomy by laparotomy. The operative technique comprises four main phases: hysterotomy; enucleation; suture of the myomectomy site and extraction of the myoma. LM offers the possibility of a minimally invasive approach to treat medium-sized (<9 cm) subserous and intramural myomata by surgery when there are only two or three of them. When conducted by experienced surgeons, the risk of peri-operative complications is no higher using this technique. Use of the laparoscopic route could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of post-operative adhesions as compared with laparotomy. Spontaneous uterine rupture seems to be rare after LM but further studies are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. The risk of recurrence seems to be higher after LM than after myomectomy performed by laparotomy.
Key words: laparoscopy / leiomyomata / myomectomy / post-operative adhesions / risk of haemorrhage
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