Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-tn8tq Total loading time: 0 Render date: 2024-07-08T01:55:35.614Z Has data issue: false hasContentIssue false

Chapter 48 - Myomectomy

from Section 10 - Operative Gynaecology

Published online by Cambridge University Press:  24 November 2021

By
Claire Cardaillac ,
Edouard Vaucel ,
Norbert Winer ,
Anais Mortier ,
Pauline Gueudry ,
Vincent Dochez  and
Thibault Thubert
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Uterine leiomyomas or fibroids are common benign tumours of the uterus. Myomectomy is performed via laparoscopy, laparotomy or hysteroscopy depending on the location of the myoma, the size and the symptoms. Before myomectomy, the patient must be informed of the risk to undergo conversion of the surgical techniques as well as about myoma recurrence. Administration of a GnRH agonist for 4 months before myomectomy improves pre and postoperative haemoglobin levels and reduces the size of the myoma. In the case of submucosal myomas of FIGO type 0, 1 and 2, which are <4 cm in diameter, hysteroscopic myomectomy is the preferred approach and significantly improves pregnancy rates. The laparoscopic approach is feasible when the number of fibroids is low, and they have a small diameter.

Keywords

myomasfibroidsmyomectomylaparoscopichysteroscopic
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 424 - 431
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Thubert, T, Foulot, H, Vinchant, M, et al. Surgical treatment: myomectomy and hysterectomy–endoscopy: a major advancement. Best Prac Res Clin Obstet Gynaecol 2016;34:104–121.CrossRefGoogle ScholarPubMed
Sinai Talaulikar, V. Medical therapy for fibroids: an overview. Best Prac Res Clin Obstet Gynaecol 2018;46:48–56.Google Scholar
Zepiridis, LI, Grimbizis, GF, Tarlatzis, BC. Infertility and uterine fibroids. Best Prac Res Clin Obstet Gynaecol 2016;34:66–73.Google Scholar
Pritts, EA, Parker, WH, Olive, DL. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril 2009;91:1215–1223.CrossRefGoogle ScholarPubMed
Levesque, A, Riant, T, Ploteau, S, Rigaud, J, Labat, J-J. Clinical criteria of central sensitization in chronic pelvic and perineal pain (Convergences PP Criteria): elaboration of a clinical evaluation tool based on formal expert consensus. Pain Med 2018. doi:10.1093/pm/pny030.CrossRefGoogle Scholar
Ludwin, A, Ludwin, I, Pityński, K, et al. Transrectal ultrasound-guided hysteroscopic myomectomy of submucosal myomas with a varying degree of myometrial penetration. J Minim Invasive Gynecol 2013;20:672–685.CrossRefGoogle ScholarPubMed
Yang, J-H, Lin, B-L. Changes in myometrial thickness during hysteroscopic resection of deeply invasive submucous myomas. J Am Assoc Gynecologic Laparoscopists 2001;8:501–505.Google Scholar
Marret, H, Fritel, X, Ouldamer, L, et al. Therapeutic management of uterine fibroid tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol 2012;165:156–164.Google Scholar
Lethaby, A, Vollenhoven, B, Sowter, MC Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev 2001.doi:10.1002/14651858.CD000547.Google Scholar
Donnez, J, Tomaszewski, J, Vázquez, F, et al. Ulipristal acetate versus leuprolide acetate for uterine fibroids. N Engl J Med 2012;366:421–432.Google Scholar
Goldman, KN, Hirshfeld-Cytron, JE, Pavone, M-E, et al. Uterine artery embolization immediately preceding laparoscopic myomectomy. Int J Gynecol Obstet 2012;116:105–108.CrossRefGoogle ScholarPubMed
Dubuisson, J, Ramyead, L, Streuli, I. The role of preventive uterine artery occlusion during laparoscopic myomectomy: a review of the literature. Arch Gynecol Obstet 2015;291:737–743.Google Scholar
Bhave Chittawar, P, Franik, S, Pouwer, AW, Farquhar, C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev 2014. doi:10.1002/14651858.CD004638.pub3.Google Scholar
Shimanuki, H, Takeuchi, H, Kitade, M, et al. The effect of vasopressin on local and general circulation during laparoscopic surgery. J Minim Invasive Gynecol 2006;13:190–194.CrossRefGoogle ScholarPubMed
ten Broek, RPG, Stommel, MWJ, Strik, C, et al. Benefits and harms of adhesion barriers for abdominal surgery: a systematic review and meta-analysis. Lancet 2014;383:48–59.Google Scholar
Takeuchi, H, Kitade, M, Kikuchi, I, et al. Adhesion-prevention effects of fibrin sealants after laparoscopic myomectomy as determined by second-look laparoscopy: a prospective, randomized, controlled study. J Reprod Med 2005;50:571–577.Google ScholarPubMed
Bosteels, J, Weyers, S, Puttemans, P, et al. The effectiveness of hysteroscopy in improving pregnancy rates in subfertile women without other gynaecological symptoms: a systematic review. Hum Reprod Update 2010;16:1–11.Google Scholar
Polyzos, NP, Zavos, A, Valachis, A, et al. Misoprostol prior to hysteroscopy in premenopausal and post-menopausal women: a systematic review and meta-analysis. Hum Reprod Update 2012;18:393–404.Google Scholar
Haimovich, S, Mancebo, G, Alameda, F, et al. Feasibility of a new two-step procedure for office hysteroscopic resection of submucous myomas: results of a pilot study. Eur J Obstet Gynecol Reprod Biol 2013;168:191–194.Google Scholar
Munro, MG. Hysteroscopic myomectomy of FIGO type 2 leiomyomas under local anesthesia: bipolar radiofrequency needle-based release followed by electromechanical morcellation. J Minim Invasive Gynecol 2016;23:12–13.Google Scholar
Hamerlynck, TWO, Dietz, V, Schoot, BC. Clinical implementation of the hysteroscopic morcellator for removal of intrauterine myomas and polyps: a retrospective descriptive study. Gynecolog Surg 2011;8:193–196.Google Scholar
Mazzon, I, Favilli, A, Grasso, M, et al. Predicting success of single step hysteroscopic myomectomy: a single centre large cohort study of single myomas. Int J Surg 2015;22:10–14.Google Scholar
Korkmazer, E, Tekin, B, Solak, N. Ultrasound guidance during hysteroscopic myomectomy in G1 and G2 submucous myomas: for a safer one step surgery. Eur J Obstet Gynecol Reprod Biol 2016;203:108–111.CrossRefGoogle ScholarPubMed
Wang, D, Wang, L, Wang, Y, Lin, X. Retracted: the efficiency and safety of tranexamic acid for reducing blood loss in open myomectomy. Medicine 2017;96:e7072.Google Scholar
Altgassen, C, Kuss, S, Berger, U, et al. Complications in laparoscopic myomectomy. Surg Endoscopy 2006;20:614–618.Google Scholar
Bosteels, J, Weyers, S, Mol, BWJ, D’Hooghe, T. Anti-adhesion barrier gels following operative hysteroscopy for treating female infertility: a systematic review and meta-analysis. Gynecolog Surg 2014;11:113–127.Google Scholar
Fauconnier, A. Recurrence of leiomyomata after myomectomy. Hum Reprod Update 2000;6:595–602.CrossRefGoogle ScholarPubMed
Yoo, E-H, Lee, PI, Huh, C-Y, et al. Predictors of leiomyoma recurrence after laparoscopic myomectomy. J Minim Invasive Gynecol 2007;14:690–697.CrossRefGoogle ScholarPubMed
Radosa, MP, Owsianowski, Z, Mothes, A, et al. Long-term risk of fibroid recurrence after laparoscopic myomectomy. Eur J Obstet Gynecol Reprod Biol 2014;180:35–39.CrossRefGoogle ScholarPubMed
Palomba, S, Zupi, E, Russo, T, et al. A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short-term outcomes. Fertil Steril 2007;88:942–951.Google Scholar
Casini, ML, Rossi, F, Agostini, R, Unfer, V. Effects of the position of fibroids on fertility. Gynecolog Endocrinol 2006;22:106–109.CrossRefGoogle ScholarPubMed
Parker, WH, Einarsson, J, Istre, O, Dubuisson, J-B. Risk factors for uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol 2010;17:551–554.Google Scholar
Kumakiri, J, Takeuchi, H, Itoh, S, et al. Prospective evaluation for the feasibility and safety of vaginal birth after laparoscopic myomectomy. J Minim Invasive Gynecol 2008;15:420–424.CrossRefGoogle ScholarPubMed
Milazzo, GN, Catalano, A, Badia, V, Mallozzi, M, Caserta, D. Myoma and myomectomy: poor evidence concern in pregnancy. J Obstet Gynaecol Res 2017;43:1789–1804.Google Scholar
Saccardi, C, Visentin, S, Noventa, M, et al. Uncertainties about laparoscopic myomectomy during pregnancy: a lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case. Minim Invasiv Ther 2015;24:189–194.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×