Maximizing myomectomy.(The Master Class)

Laparoscopic myomectomy is a safe surgical procedure with a low complication rate.

For patients interested in future fertility, it is without question a better alternative to hysterectomy in managing fibroids.

Laparoscopic myomectomy can nearly always be performed on an outpatient basis, requires a short recovery time, and, especially important in the context of delayed childbearing, has decreased adhesions relative to laparotomy.

Of course, laparoscopic myomectomy is a challenge for the surgeon. It can be more time consuming than performing a hysterectomy, although surgical time decreases with experience. Similarly, the more you do, the more patients you will be able to count as good candidates, because you will become more adept at managing large and/or multiple myomas.

I recently completed a retrospective study of 296 laparoscopic myomectomy patients I managed from August 1999 to February 2003.

Of 188 cases in which myoma weight was recorded, 49 (26%) had myoma weights of at least 250 g. There were 25 minor and 6 major complications (hernia, pulmonary embolism, pelvic abscess, pelvic infection, and two post-operative bleeds). There was no relationship between the complications and the number or size of myomas.

Interestingly, I have since performed 100 more laparoscopic myomectomies without complication.