Laparoscopic myomectomy: a current view

Since 1990 laparoscopic myomectomy (LM) has provided an alternative to lapa rotomy when intramural and subserous myomata are to be managed surgically. However, this technique is still the subject of debate. Based on their own experience together with data from the literature, the authors report on th e situation today regarding the operative technique for LM and the risks an d benefits of the technique as compared with myomectomy by laparotomy. The operative technique comprises four main phases: hysterotomy; enucleation; s uture of the myomectomy site and extraction of the myoma. LM offers the pos sibility of a minimally invasive approach to treat medium-sized (<9 cm) sub serous and intramural myomata by surgery when there are only two or three o f them. When conducted by experienced surgeons, the risk of peri-operative complications is no higher using this technique. Use of the laparoscopic ro ute could reduce the haemorrhagic risk associated with myomectomy. LM could reduce also the risk of post-operative adhesions as compared with laparoto my. Spontaneous uterine rupture seems to be rare after LM but further studi es are needed before it can be said whether the strength of the hysterotomy scars after LM is equivalent to that obtained after laparotomy. The risk o f recurrence seems to be higher after LM than after myomectomy performed by laparotomy.