Myomectomy

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, with a late marriage and a very big uterus of 1 kg. Notwithstanding the statement of the Gruppo Italo Belga that this was an indication to do a hysterectomy, I refused a hysterectomy and 18 myomas were removed.

Less than 1 year later, I delivered a boy. I am lucky.

a general practitioner in Rome