3. Fibroids (leiomyomas) are benign
smooth muscle cell tumors of the uterus.
Although they are extremely common,
with an overall incidence of 40% to 60%
by age 35 and 70% to 80% by age 50,
the precise etiology of uterine fibroids
remains unclear.
4. Described based on location in the
uterus:
• Intramural: develop from within uterine
wall, do not distort uterine cavity, <50%
protruding into serosal surface.
• Submucosal: develop from myometrial
cells just below endometrium, often
protrude into and distort uterine cavity.
5. • Subserosal: originate from
serosal surface of uterus, >50%
protrudes out of serosal surface.
• Cervical: located in the cervix,
rather than uterine corpus.
6.
7.
8.
9.
10. It was first described at 1979 by Semm,
exclusively for subserous myoma.
From the beginning of 1990s, the
technique was developed to include
extraction of intramural myoma.
11. Should be particularly meticulous, there is
no intraoperative palpation.
• TAS , TVS.
• Doppler assement.
• MRI.
• Diagnosic hysteroscopy, In selected cases.
14. Each myoma must be excised via its own
hysterotomy.
Preventive occlusion of the uterine artery,
using a clip, is prefered to decrease intra-
operative Hge.
15. Dissection must take place along the
cleavage plane.
Avoid iatrogenic lesions of the other pelvic
organs.
Meticulous closure of myomectomy site.
16.
17.
18.
19.
20.
21.
22. Direct suprapubic extraction for small
myoma.
Posterior colpotomy.
Electric morcellation.
23. Broad ligament access to the uterine
artery.
Posterior access to the uterine artery.
30. Incidence: variable (5-40%)
Factor increase the conversion rate:
• Size of the dominant myoma at ultrasonography.
• Anterior location.
• Intramural type.
• Preoperative use of GnRH agonists.
31. There are several arguments suggesting
that the laparoscopic approach reduces
the risk of postoperative adhesions after
myomectomy.
32. Only 2 randomized controlled trials
compared myomectomy by laparotomy or
laparoscopy.
There was no significant differences in the
pregnancy and abortion rate.
Seracchioli et al 2000, Palomba et al 2007.
33. There is considerable debate concerning
the strength of hysterotomy scars after
laparoscopic myomectomy.
Particular care must be given to uterine
closure.
34.
35. Rate is higher than laparotomy & the time
lapse before recurrence is shorter.
It is impossible to palpate the myometrium
thoroughly, and small intramural nuclei
which do not deform the uterine serosa
can be overlooked.
36.
37. Advantages:
• 3-dimensional image.
• Absence of tremor.
• Superior instrument articulation.
• Comfort for the surgeon.
• Faster learning curve.
38.
39. Laparoscopic myomectomy is a safe
technique which has several advantages,
including less postoperative pain, shorter
recovery time and reduced post-
myomectomy adhesion formation in
comparison with the laparotomy.
40. However, it is a difficult operation, and the
surgeon needs to be well experienced in
laparoscopic surgery.
