Download PDF
Semin Reprod Med 2004; 22(2): 149-155
DOI: 10.1055/s-2004-828621
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Endoscopic Management of Leiomyomata

Arnold P. Advincula1 , Arleen Song1
  • 1Department of Obstetrics and Gynecology, University of Michigan Medical Center, L 4000 Women's Hospital, Ann Arbor, Michigan
Further Information

Publication History

Publication Date:
26 May 2004 (online)

    Permissions and Reprints

Prior to the advent of modern minimally invasive surgery techniques, the primary surgical management of symptomatic leiomyomata for women desiring future fertility or uterine conservation was through laparotomy. Today, many cases of intramural and subserous leiomyomata are managed with laparoscopic myomectomy and selected cases of submucosal leiomyomata are managed with hysteroscopic myomectomy. The management of leiomyomata endoscopically is one of the more challenging procedures in minimally invasive surgery and requires a skilled surgeon. Despite its benefits, such as faster postoperative recovery and potentially less postoperative adhesions compared with laparotomy, many concerns still exist. Although pregnancy rates for women with leiomyomata managed endoscopically are similar to those after laparotomy, a major worry continues to be the risk of uterine rupture. The risk is essentially unknown. Lastly, the risk of recurrence seems higher after laparoscopic myomectomy compared with laparotomy.

KEYWORDS

Laparoscopic myomectomy - hysteroscopic myomectomy - uterine rupture - surgical technique

REFERENCES

  • 1 Seracchioli R, Rossi S, Govoni F et al.. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy.  Hum Reprod. 2000;  15 2663-2668
    CrossrefPubMedGoogle Scholar
  • 2 Mais V, Ajossa S, Guerriero S et al.. Laparoscopic versus abdominal myomectomy: a prospective randomized trial to evaluate benefits in early outcome.  Am J Obstet Gynecol. 1996;  174 654-658
    CrossrefPubMedGoogle Scholar
  • 3 Stringer N H, Walker J C, Meyer P M. Comparison of 49 laparoscopic myomectomies with 49 open myomectomies.  J Am Assoc Gynecol Laparosc. 1997;  4 457-464
    CrossrefPubMedGoogle Scholar
  • 4 Dubuisson J B, Lecuru F, Foulot H, Mandelbrot L, Aubriot F X, Mouly M. Myomectomy by laparoscopy: a preliminary report of 43 cases.  Fertil Steril. 1991;  56 827-830
    PubMedGoogle Scholar
  • 5 Takeuchi H, Kuwatsuru R. The indications, surgical techniques, and limitations of laparoscopic myomectomy.  JSLS. 2003;  7 89-95
    PubMedGoogle Scholar
  • 6 Koh C H, Janik G M. Laparoscopic microsurgical tubal anastomosis: difficulties and pitfalls. In: Corfman RS, Diamond MP, DeCherney A Complications of Laparoscopy and Hysteroscopy. 2nd ed. Malden, MA; Blackwell Science 1997: 107-113
    Google Scholar
  • 7 Dubuisson J B, Fauconnier A, Babaki-Fard K et al.. Laparoscopic myomectomy: a current review.  Hum Reprod Update. 2000;  6 588-594
    CrossrefPubMedGoogle Scholar
  • 8 Verkauf B S. Myomectomy for fertility enhancement and preservation.  Fertil Steril. 1992;  58 1-15
    PubMedGoogle Scholar
  • 9 Igarashi M. Value of myomectomy in the treatment of infertility.  Fertil Steril. 1993;  59 1331-1332
    PubMedGoogle Scholar
  • 10 Stringer N H. Laparoscopic myomectomy with the endo stitch 10-mm laparoscopic suturing device.  J Am Assoc Gynecol Laparosc. 1996;  3 299-303
    PubMedGoogle Scholar
  • 11 Advincula A P, Reynolds R K, Kartha P. Telerobotic laparoscopic hysterectomy and myomectomy case series. Abstract presented at: SLS Annual Meeting, 12th International Congress and Endo Expo September 24, 2003 Las Vegas, NV;
    Google Scholar
  • 12 Hulka J F, Reich H. Laparoscopic myomectomy. In: Hulka JF, Reich H Textbook of Laparoscopy. 3rd ed. Philadelphia; WB Saunders 1998: 415-430
    Google Scholar
  • 13 Dubuisson J B, Fauconnier A, Fourchotte V et al.. Laparoscopic myomectomy: predicting the risk of conversion to an open procedure.  Hum Reprod. 2001;  16 1726-1731
    CrossrefPubMedGoogle Scholar
  • 14 Zullo F, Pellicano M, Stefano R et al.. A prospective randomized study to evaluate leuprolide acetate treatment before laparoscopic myomectomy: efficacy and ultrasonographic predictors.  Am J Obstet Gynecol. 1998;  178 108-112
    PubMedGoogle Scholar
  • 15 Campo S, Garcea N. Laparoscopic myomectomy in premenopausal women with and without pre-operative treatment using gonadotrophin-releasing hormone analogues.  Hum Reprod. 1999;  14 44-48
    CrossrefPubMedGoogle Scholar
  • 16 Rossetti A, Sizzi O, Soranna L et al.. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy.  Hum Reprod. 2001;  16 770-774
    CrossrefPubMedGoogle Scholar
  • 17 Dubuisson J B, Chapron C, Fauconnier A. Laparoscopic myomectomy. In: Sutton C, Diamond MP Endoscopic Surgery for Gynecologists. 2nd ed. London; WB Saunders 1998: 272-279
    Google Scholar
  • 18 Falcone T, Bedaiwy M A. Minimally invasive management of uterine fibroids.  Curr Opin Obstet Gynecol. 2002;  14 401-407
    CrossrefPubMedGoogle Scholar
  • 19 Hasbargen U, Summerer-Moustaki M, Hillemanns P et al.. Uterine dehiscence in a nullipara, diagnosed by MRI, following use of unipolar electrocautery during laparoscopic myomectomy: case report.  Hum Reprod. 2002;  17 2180-2182
    CrossrefPubMedGoogle Scholar
  • 20 Pelosi III M A, Pelosi M A. Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy.  Am J Obstet Gynecol. 1997;  177 1547-1549
    CrossrefPubMedGoogle Scholar
  • 21 Hockstein S. Spontaneous uterine rupture in the early third trimester after laparoscopically assisted myomectomy. A case report.  J Reprod Med. 2000;  45 139-141
    PubMedGoogle Scholar
  • 22 Dubuisson J B, Chavet X, Chapron C et al.. Uterine rupture during pregnancy after laparoscopic myomectomy.  Hum Reprod. 1995;  10 1475-1477
    PubMedGoogle Scholar
  • 23 Harris W J. Uterine dehiscence following laparoscopic myomectomy.  Obstet Gynecol. 1992;  80 545-546
    PubMedGoogle Scholar
  • 24 Dubuisson J B, Fauconnier A, Deffarges J V et al.. Pregnancy outcome and deliveries following laparoscopic myomectomy.  Hum Reprod. 2000;  15 869-873
    CrossrefPubMedGoogle Scholar
  • 25 Dessolle L, Soriano D, Poncelet C et al.. Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility.  Fertil Steril. 2001;  76 370-374
    CrossrefPubMedGoogle Scholar
  • 26 Seinera P, Farina C, Todros T. Laparoscopic myomectomy and subsequent pregnancy: results in 54 patients.  Hum Reprod. 2000;  15 1993-1996
    CrossrefPubMedGoogle Scholar
  • 27 Darai E, Dechaud H, Benifla J L et al.. Fertility after laparoscopic myomectomy: preliminary results.  Hum Reprod. 1997;  12 1931-1934
    CrossrefPubMedGoogle Scholar
  • 28 Nezhat C, Nezhat F, Bess O et al.. Laparoscopically assisted myomectomy: a report of a new technique in 57 cases.  Int J Fertil Menopausal Stud. 1994;  39 39-44
    PubMedGoogle Scholar
  • 29 Buttram Jr V C, Reiter R C. Uterine leiomyomata: etiology, symptomatology, and management.  Fertil Steril. 1981;  36 433-445
    PubMedGoogle Scholar
  • 30 Doridot V, Dubuisson J B, Chapron C et al.. Recurrence of leiomyomata after laparoscopic myomectomy.  J Am Assoc Gynecol Laparosc. 2001;  8 495-500
    CrossrefPubMedGoogle Scholar
  • 31 Nezhat F R, Roemisch M, Nezhat C H et al.. Recurrence rate after laparoscopic myomectomy.  J Am Assoc Gynecol Laparosc. 1998;  5 237-240
    PubMedGoogle Scholar
  • 32 Bulletti C, Polli V, Negrini V et al.. Adhesion formation after laparoscopic myomectomy.  J Am Assoc Gynecol Laparosc. 1996;  3 533-536
    CrossrefPubMedGoogle Scholar
  • 33 Takeuchi H, Kinoshita K. Evaluation of adhesion formation after laparoscopic myomectomy by systematic second-look microlaparoscopy.  J Am Assoc Gynecol Laparosc. 2002;  9 442-446
    CrossrefPubMedGoogle Scholar
  • 34 Dubuisson J B, Fauconnier A, Chapron C et al.. Second look after laparoscopic myomectomy.  Hum Reprod. 1998;  13 2102-2106
    CrossrefPubMedGoogle Scholar
  • 35 Neuwirth R S. A new technique for and additional experience with hysteroscopic resection of submucous fibroids.  Am J Obstet Gynecol. 1978;  131 91-94
    PubMedGoogle Scholar
  • 36 Wamsteker K, Emanuel M H, de Kruif J H. Transcervical hysteroscopic resection of submucous fibroids for abnormal bleeding: results regarding the degree of intramural extension.  Obstet Gynecol. 1993;  82 736-740
    PubMedGoogle Scholar
  • 37 Brandner P, Klaus J N, Diebold P. Hysteroscopic resection of submucous myomas.  Contrib Gynecol Obstet. 2000;  20 81-90
    PubMedGoogle Scholar
  • 38 Propst A M, Liberman R F, Harlow B L, Ginsburg E S. Complications of hysteroscopic surgery: predicting patients at risk.  Obstet Gynecol. 2000;  96 517-520
    CrossrefPubMedGoogle Scholar
  • 39 Witz C A, Silverberg K M, Burns W N et al.. Complications associated with the absorption of hysteroscopic fluid media.  Fertil Steril. 1993;  60 745-756
    PubMedGoogle Scholar
  • 40 Kochli O R. Endometrial ablation in the year 2000: do we have more methods than indications?.  Contrib Gynecol Obstet. 2000;  20 91-120
    PubMedGoogle Scholar
  • 41 Loffler F D, Bradley L D, Brill A I et al.. Hysteroscopic fluid monitoring guidelines.  J Am Assoc Gynecol Laparosc. 2000;  7 167-168
    PubMedGoogle Scholar
  • 42 Bradley L M. Complications in hysteroscopy: prevention, treatment, and legal risk.  Curr Opin Obstet Gynecol. 2002;  14 409-415
    CrossrefPubMedGoogle Scholar
  • 43 Bajekal N, Li T C. Fibroids, infertility, and pregnancy wastage.  Hum Reprod Update. 2000;  6 614-620
    CrossrefPubMedGoogle Scholar
  • 44 Pritts E A. Fibroids and infertility: a systematic review of the evidence.  Obstet Gynecol Surv. 2001;  56 483-491
    CrossrefPubMedGoogle Scholar

Arnold P AdvinculaM.D. 

Clinical Assistant Professor, Department of Obstetrics and Gynecology, University of Michigan Medical Center

L 4000 Women's Hospital, 1500 East Medical Center Drive

Ann Arbor, MI 48109