Page 41 - World Journal of Laparoscopic Surgery

Pregnancy Outcomes Following Laparoscopic Myomectomy

technique of full thickness, evenly spaced suture placement, 7. Dubuisson JB, Chapron C, Chavet X, et al. Fertility after
thus avoiding hematoma formation. Overaggressive control of laparoscopic myomectomy of large intramural myomas:
bleeders using electrosurgical techniques should be avoided. preliminary results. Hum Reprod 1996;11,518-22.
Increasing the numbers or layers of sutures without adhering 8. Dubuisson JB, Chapron C, Levy L. Difficulties and
to the above principles may in fact compromise healing by complications of laparoscopic myomectomy. J Gynecol Surg
causing tissue ischemia. Paul et al, 2006, found that uterine 1996;12:159-65.
rupture following laparoscopic myomectomy is rare following 9. Dubuisson JB, Chavet X, Chapron C, et al. Uterine rupture
single-layer myometrial closure. This data though reassuring during pregnancy after laparoscopic myomectomy. Hum Reprod
are not conclusive, and there is a need for a randomized study 1995;10,1475-7.
to compare single-layer and multilayer suturing techniques. 10. Goldberg J, Pereira L. Pregnancy outcomes following treatment
for fibroids: uterine fibroid embolization versus laparoscopic
CONCLUSIONS myomectomy.Curr Opin Obstet Gynecol 2006;18(4),402-6.
11. Hurst BS, Matthews ML, Marshburn PB. Laparoscopic
LM enables surgical treatment of subserous and intramural
myomata of average size (< 9 cm) and a few in number. When myomectomy for symptomatic uterine myomas. Fertil Steril
the surgeons are sufficiently experienced this technique does 2005;83,1-23.
not involve a greater risk of operative complications. LM might 12. Kucera E, Dvorská M, Krepelka P, Herman H. Pregnancy after
reduce the risk of postoperative adhesions compared with laparoscopic myomectomy—long-term follow-up: Ceska
laparotomy, which is a considerable advantage in a context of Gynekol 2006;71(5),389-93.
surgery for infertility. At present there is not enough evidence 13. Landi S, Fiaccavento A, Zaccoletti R, Barbieri F, Syed R, Minelli
to say whether the hysterotomy scars after LM are as strong as L. Pregnancy outcomes and deliveries after laparoscopic
those obtained after laparotomy. The risk of uterine rupture myomectomy. J Am Assoc Gynecol Laparosc 2003;10,177-81.
after LM seems low, however, and should not constitute a 14. Landi S, Fiaccavento A, Zaccoletti R, Barbieri F, Syed R, Minelli
counter-indication for this operation if pregnancy is desired, L. Pregnancy outcomes and deliveries after laparoscopic
provided that the myomectomy is truly justified. If good quality myomectomy. J Am Assoc Gynecol Laparosc 2003;10(2),177-
uterine scar is to be obtained, the surgeons need to be very 81.
experienced in laparoscopic surgery and to pay particular care 15. Li TC, Mortimer R, Cooke ID. Myomectomy: a retrospective
when suturing the uterus. Obstetricians dealing with antenatal study to examine reproductive performance before and after
patients with a history of a myomectomy before should be aware surgery. Hum Reprod 1999;14,1735-40.
of possible complications and should consider management of 16. Mais V, Ajossa S, Guerriero S, et al. Laparoscopic versus
such patients as in cases of post-cesarean pregnancies. abdominal myomectomy: a prospective, randomized trial to
evaluate benefits in early outcome. Am J Obstet Gynecot
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