The role of laparoscopic myomectomy in the modern management of uterine fibroids – a literature review
L. Ples, A. Rîcu, B. Banescu, R. Sima, A.D. Stanescu
Rezumat: Uterine fibroids are the most commonbenign tumors of
the genital female tract and the leading indication for
hysterectomies in the USA. The prevalence rates quoted
in literature range from 20-50%, based on postmortem
studies. The prevalence varies with age, with an increase
in the late reproductive period. Since the beginning of
1990s 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 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 include four main stage: hysterotomy;
enucleation; suture of the myomectomy site and extraction
of the myoma. A consensus gradually emerges that
the maximal size of myoma must be 8-10 cm and the
total number of fibroids should not exceed four. When
conducted by experienced surgeons, the risk of perioperative
complications is no higher using this technique. The use
of laparoscopic approach could reduce the haemorrhagic
risk associated with myomectomy. LM could reduce also
the risk of postoperative 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.
Some studies showed that the risk of recurrence seems to
be higher after LM than after myomectomy performed by
laparotomy. Laparoscopic myomectomy cases may become
difficult if bleeding problems occur. Extended operative
times may be necessary for morcellation and extensive
laparoscopic suturing. Gynecologists need to improve
their laparoscopic skills, as minimally invasive surgery is
becoming the sine qua non condition of a modern surgeon. Cuvinte cheie: fibroid, laparoscopy, myomectomy.