Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Athanasios Zikopoulos,Minas Paschopoulos,Maria Paraskevaidi,Yannis Prapas,Konstantinos Zikopoulos,Apostolia Galani,Efstratios Kolibianakis,Orestis Tsonis,Charalampos Siristatidis

doi:10.4236/ijcm.2021.1210038

Abstract

Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.

Highlights

Uterine leiomyomas, are the most common benign tumours in the reproductive system of childbearing age women, with a prevalence of 30% - 35% [1] [2] [3]
Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells
Uterine leiomyomas are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix, and are surrounded by a pseudocapsule of compressed areolar tissue and smooth muscle cells

Summary

Introduction

Uterine leiomyomas, ( known as fibroids or myomas), are the most common benign tumours in the reproductive system of childbearing age women, with a prevalence of 30% - 35% [1] [2] [3]. Uterine leiomyomas are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix (fibronectin, collagen, proteoglycan), and are surrounded by a pseudocapsule of compressed areolar tissue and smooth muscle cells. This pseudocapsule contains very few blood vessels and lymphatic vessels. Preservation of the uterine anatomical and functional integrity during myomectomy, especially in women of reproductive age, is of imminent importance. The restoration and maintenance of the physiologic function of the uterus is or should be, the ultimate goal of surgical treatment

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