Myomectomy

Indications for myomectomy

In women still wanting a pregnancy, a unique myoma can almost always be removed by laparoscopy. Also multiple myoma’s can be removed but the fertility outcome decreases with the number of myoma’s and the duration of surgery.

Still,  however, I recall over the many years several patients one of over 40 with  a sigle myoma of 10 cm who today has 3 children and another one, a GP of 42 who got pregnant 3 months after the removal of 18 myoma’s ans 2.5 hour surgery.

If pregnancy no longer is an isssue it is preferable to do an hysterectomy than a myomectomy for large or multiple myomas  since this is technically easier and faster.

In younger women, psychology should also be taken into account when deciding with the patient whether a simple myomectomy or an hysterectomy should be performed.  In addition the risk of recurrences should be evaluated.

Technique of myomectomy.

A myomectomy generally is not that difficult. The critical part is bleeding and the suturing of the wall, which I consider should be done by a running suture. Both aspects mainly relate to the experience of the surgeon.