Pregnancy Outcomes after Laparoscopic Myomectomy with Ultrasonic Energy and Laparoscopic Suturing of the Endometrial Cavity

Abstract

Study Objective To evaluate pregnancy outcomes in women with laparoscopic removal of myomas that resulted in entry into the endometrial cavity and required laparoscopic repair of the endometrial cavity. Design Retrospective chart review (Canadian Task Force classification II-2). Setting Private obstetrics-gynecology practice and departments of obstetrics and gynecology at two university-affiliated hospitals. Patients Seven women with symptomatic uterine leiomyomata treated by laparoscopic myomectomy, who achieved pregnancy. Intervention Laparoscopic dissection of myomas with the ultrasonic scalpel and laparoscopic suturing of the uterus with the Endo Stitch device in three layers. Measurements and Main Results Indications for laparoscopic myomectomies were excessive bleeding and significant growth of uterine myomas. The size of myomas in all patients ranged from 12 to 2 cm. Average operating time was 232.8 minutes and average blood loss was 117.8 ml. The largest number of myomas removed from a single patient was nine. All procedures were performed on an outpatient basis and no complications occurred. All women easily achieved pregnancy and four were delivered at or near term by cesarean section. One delivered vaginally at 28 weeks secondary to uncontrolled premature labor, without uterine dehiscence. Two had elective terminations at 8 weeks. Conclusion Laparoscopic suturing of the endometrial cavity in three layers does not prevent future pregnancies, and pregnancies can progress to term and in some cases be delivered vaginally without dehiscence.