Indications for a
- 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
- small myoma’s with distortion of the cavity
- and symptoms
- to discuss : outpatietn OPIUM 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
- oestro-progestagens are not useful
- LHRH can reduce blood flow
- ESMYA, an antiprogestagen is no longer used
- 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.