Page 37 - World Journal of Laparoscopic Surgery

Pregnancy Outcomes Following Laparoscopic Myomectomy
World Journal of Laparoscopic Surgery, January-April 2008;1(1):35-40
Pregnancy Outcomes Following

Laparoscopic Myomectomy

Hanom Husni Syam
Obstetrician and Gynecologist Specialist, Diploma in Minimal Access Surgery (Laparoscopy)
Member World Association of Laparoscopic Surgeon (WALS), Department of Obstetric and Gynecology
Trisakti University Jakarta, Teratai Fertility (IVF) Clinic Gading Pluit Hospital Jakarta

Abstract myomectomy has been reported to be an effective technique
Background: The laparoscopic approach to myomectomy has raised that is associated with a low rate of patient morbidity (Dubuisson
questions about the risk of uterine rupture in patients who become et al, 1996). Because myomectomy is often performed to preserve
pregnant following surgery. It has been suggested that the rupture the uterus for future pregnancy, maintaining the integrity of the
outside labor in pregnancies following laparoscopic myomectomy can uterine wall is of utmost importance (Dubuisson et al, 1995).
be due to the difficulty of suturing or to the presence of a hematoma or It is found that there is an increasing concern over the
to the wide use of radiofrequencies.
incidence of uterine rupture in pregnant women with a history
Aim: To assess the outcome of pregnancy following laparoscopic of an earlier laparoscopic myomectomy. The fact that uterine
myomectomy. rupture has been reported remote from term and following
Methods: A literature search performed using engine Google, High myomectomies performed for subserous and even pedunculated
wire press, Springer link, and Yahoo. Selected papers screened for myomas (Dubuisson et al, 2000) are especially worrying. Uterine
other related reports. rupture has also been reported to occur without signs of fetal
distress. Most cases of uterine rupture have been described as
Results: There were no incidents of uterine scar rupture in any of these isolated case reports, and several case series have had no or
studies.
very low rates of this complication (Dubuisson et al, 2000;
Conclusions: Uterine rupture during pregnancies following Seinera et al, 2000).
laparoscopic myomectomy is rare. This review article did not confirm
the hypothesis that laparoscopic myomectomy is associated with an OPERATIVE TECHNIQUES
increased risk for uterine dehiscence during pregnancy.
The difficulties in the operation, as with myomectomy by
Keywords: Laparoscopic myomectomy, pregnancy, and uterine laparotomy, are the risk of peroperative hemorrhage and the
rupture
prevention of postoperative adhesions. Use of the laparoscopic
route for the myomectomy also raises certain particular problems
INTRODUCTION
connected with this approach: bloodless enucleation of the
Nowadays, laparoscopic myomectomy has become the elective myomata is absolutely essential and a perfect suture must be
procedure in selected patients. Laparoscopy effectively achieved to obtain a good quality scar. There are several
shortens the hospital stay and avoids the major risk of the principles to use of the LM technique (Dubuisson et al, 2000).
classical route, i.e. adhesion formation. Laparoscopic The principles of microsurgery must be applied to LM:
myomectomy (LM) is a recently introduced technique that avoidance of intraperitoneal contamination; use of fine and
enables intramural and subserous myomas < 9 cm in size and atraumatic instruments; gentle and atraumatic manipulation of
few in number to be managed by surgery. The rate of the uterus without grasping the pelvic organs (except the myoma
complications in the short-term is low, provided that the itself).
surgeons are suitably trained (Dubuisson et al, 1996). Compared When performed LM, each myoma must be excised via its
with myomectomy by laparotomy, LM offers reduced own hysterotomy: it cannot use the same technique as
postoperative pain, a shorter hospital stay, and quicker return myomectomy by laparotomy that is, removing all the myomata
to normal activity (Mais et al, 1996). When pregnancy is desired, present on the uterus via an anterior sagittal hysterotomy.
the technique appears particularly advantageous in that it could Dissection must take place in every case along the cleavage
reduce the risk of postoperative adhesions compared with plane separating the myoma from the adjacent myometrium.
laparotomy (Bulletti et al, 1996). In selected cases, laparoscopic This cleavage plane is bounded by a pseudo-capsule made up

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