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2009, Number 2

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Rev Mex Med Repro 2009; 1.2 (2)

Laparoscopic myomectomy

Velázquez CG, Hinojosa CJC, Serrano GMG

Language: Spanish
References: 45
Page: 47-56
PDF size: 90.26 Kb.


ABSTRACT

Uterine leiomyomas are the most frequent benign tumors in gynecological practice. More than 25 years ago, treatment options of uterine miomatosis were limited and included observation, hysterectomy or, with less frequency, abdominal myomectomy. Nowadays, a number of therapeutic options have been added including pharmacological treatment, laparoscopic myomectomy with different variants, hysteroscopic myomectomy, myolisis, uterine artery embolization and treatment by ultrasound with focus on the lesion identified with magnetic resonance. Myomectomy is a choice to abdominal hysterectomy for the treatment of uterine miomatosis, with the main objective of maintaining the uterus’ function for reproduction and it is indicated for women with reproductive disorders associated to uterine miomatosis; thus, it is the choice method to women who desire to preserve the uterus. Selection between abdominal and laparoscopic myomectomy should take into consideration several aspects such as: patient’s preference, health status, size, number and localization of myomas and history of abdominal or pelvic surgery, among others. Myomectomy performed by laparoscopy, specially in patients with reproductive desire, is a very controversial procedure due to some technical difficulties, such as: impossibility of touching directly the uterus and to identifying little intramural myomas; the difficulty to remove big myomas, which even may hinder the equipment placement; the difficulty to achieve delicate areas such as those near salpinges or uterine vessels, ureter and cervix, but specially the difficulty to do the careful repair of uterine wall. Technological advances have allowed the development of better instruments facilitating myomectomy, among which are: harmonic scalpel, instruments in corkscrew allowing a better myoma’s fixation, better systems of irrigation-suction, and outstandingly the development of electric morcellator allowing the extraction of myomas of any size. Besides the better optics, illumination systems, insufflation and energies. Only widely trained surgeons, with great experience in this kind of procedures and in this way, can offer performance of myomectomy.


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