Conservative surgical treatment of uterine fibroids

Abstract

Fibroids are the most common benign tumours of the genital organs in women of childbearing age, causing significant morbidity and largely disturbing quality of life. Myomectomy is a option of choice for women who want to preserve reproductive function. Conventional myomectomy via laparotomy is commonly used for large subserosal and intramural fibroids and in cases of a large number of fibroids. Number, size and location of fibroids in most cases do not represent a limiting factor for conventional myomectomy. Vaginal myomectomy is possible in cases of nascent submucosal fibroids. Laparoscopic myomectomy is an option for patients with smaller uterus, as the size of the uterus could represent a limiting factor for this approach. Hysteroscopic resection of submucosal fibroids is the method of choice for most patients with submucous fibroids. There is no consensus yet on the maximum size and type of fibroids that can be operated with this approach. Myoma pseudocapsule research during the past decade led to introduction of a surgical technique called "intracapsular myomectomy", as a method which spares the pseudocapsule as an important structure for optimal myometrial healing after myomectomy, positively affecting future reproductive function. The clinical rationale for intracapsular myomectomy can be applied to all myomectomies, therefore it has been used both for laparoscopic and laparotomic myomectomy, as well as for cesarean myomectomy. Several studies demonstrated that CM is probably safer procedure than previously believed. CM is justifiable when performed following proper patient selection by experienced surgeons.