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Indications for a

Laparoscopic myomectomy

  • a solitary myoma with symptoms as pain or bleedings
  • a pedunculated myoma at the outside of the uterus
  • a myoma of less than 8 cm in the wall
  • multiple myoma’s : consider an hysterectomy
  • a smaller submucous myoma : consider an hysteroscopic myomectomy

Hysteroscopic myomectomy

  • small myoma’s with distortion of the cavity
  • and symptoms
    • bleeding
    • infertility
  • to discuss : outpatietn OPIUM technique

Myomectomy Technique

  • Small myomas : incision - excision and suture
  • laparoscopic suture is the main difficulty
  • for bigger or multiple myoma’s : first clip the uterine artery.
  • hospitalisation¬† 1-2 days

 

Medical treatment

  • oestro-progestagens are not useful
  • LHRH can reduce blood flow
  • ESMYA, an antiprogestagen is no longer used

Results

  • a removed fibroma has no recurrences
  • symptoms are gone
  • fertility increases
  • the risk of a miscarriage is lower

What is quality ?

  • laparoscopy is generally better
  • little blood loss
  • short duration of surgery
  • adequate laparoscopic suturing
  • little adhesions

The patient should decide

I was 43, witha late marriage and a very big uterus of 1 kgr. Notwithstanding the statement of the gruppo italo belga that this was an indication to do an hysterectomy,  I opted for a laparoscopic hysterectomy and 18 myoma’s were removed.

Less than 1 year i delivered a boy.  I have been lucky.

a general practitioner in Rome

 

The gynecologist gives information.

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