1475 Laparoscopic Intracapsular Myomectomy for Deep Intramural Myomas in Infertile Women

Abstract

Video Objective Laparoscopic Intracapsular Myomectomy helps in avoiding the opening of uterine cavity in infertile women with deep intramural myomas compressing the cavity. Infertile women with deep intramural myomas compressing the cavity, laparoscopic intracapsular myomectomy may be preferred to avoid opening the uterine cavity. Setting Videos of 3 cases will be shown where infertile women needed Myomectomy to optimize fertility results Case A 33 year old woman with 3 deep intramural medium sized myomas compressing the cavity from three sides. Case B 31 year old woman, with large posterior wall intramural myoma compressing the cavity from fundus to isthmus. Case C 28 year old, regular cycles, showing 6cm by 8cm right lateral wall myoma, compressing the cavity. Interventions 3 cases demonstrating our objective are shown. In all the cases you will notice. • we remained in the intracapsular plane • finer fibers of the capsule were also cut so as to make myoma absolutely naked • Intracapsular plane is the most avascular plane • cavity was not opened Conclusion Remaining in “intracapsular plane” while performing laparoscopic myomectomy in cases of deep intramural myomas, in infertile women, should be preferred as it helps in preventing intrauterine damage. Intrauterine damage can be in the form of intrauterine adhesions, avulsion of uterine wall or scar dehiscence in future pregnancy. Haematoma formation, necrosis and secondary infection are the triad of weakening the scar. This triad automatically gets taken care of as intracapsular plane is relatively avascular, one does not need to do the cauterization of the vessels after the myomectomy over the myoma bed. It is obvious that this will avoid the necrosis and secondary infection. We prefer to take 2-3 layers suturing with V-lock to obliterate dead space.