Laparoscopic myomectomy: The Italian experience

Abstract

For many years hysterectomy has been considered the operation of choice for management of myomas instead of myomectomy, perhaps because of higher intraoperative morbidity and postoperative recurrence associated with the latter. 1 According to one group, the notion that myomectomy carries with it higher morbidity was not confirmed. 2 This may be due to improved surgical techniques. Recurrence of myomas is estimated to be approximately 15% to 30%, with a retreatment rate of 1 0 % . 3. 4 In recent years, corresponding with a rising trend to delay childbearing, myomectomy has become an increasingly common method of management. ~ Growing numbers of women are delaying their first pregnancy until their thirties and forties, thus adding infertility to the myoma problem. Several mechanisms by which myomas cause infertility have been postulated: elongation of the uterine cavity; cornual obstruction or distortion of fallopian tubes; vascularization; alteration of uterine fluid composition; and hypercontractility of myometrium. One report found that infertility and myomas were often associated, and 27% of women undergoing myomectomy experienced infertility. 3 A 50% pregnancy rate was reported after myomectomy in women with unexplained infertility. 1 The American College of Obstetricians and Gynecologists published the following guidelines for myomectomy in infertile women and in the those who request preservation of the uterus. ~ I. Leiomyomata in infertile women as a probable factor for failure to conceive or in recurrent pregnancy loss (all of the following must be present): A. In the presence of failure to conceive or recurrent pregnancy loss 1. Presence of leiomyomata of sufficient size or specific location is a probable factor. 2. No more likely explanation exists for failure to conceive or recurrent pregnancy loss. B. Before the procedure 1. Evaluate other causes of infertility. 2. Evaluate endometrial cavity and fallopian tubes. 3. Document discussion that disease process may require hysterectomy. II. Criteria for myomectomy in patients desiring to retain the uterus: A. Presence of either 1. Asymptomatic leiomyomata of such size that they are palpable abdominally and are a concern to the woman. 2. Ovulatory patients with leiomyomata as a probable cause of excessive uterine bleeding evidenced by either a. Profuse bleeding with flooding or clots, or repetitive periods lasting for more than 8 days. b. Anemia owing to acute or chronic blood loss.