Laparoscopic Myomectomy

Dubuisson, Jean‐Bernard; Chapron, Charles; Fauconnier, Arnaud; Babaki‐Fard, Katayoun

doi:10.1111/j.1749-6632.2001.tb03807.x

Cited by 40 publications

(22 citation statements)

References 18 publications

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“…A conservative surgical management include myomectomy for women who wish to retain their uterus for continuing their reproductive potential. 5 Laparoscopic myomectomy with all its advantages can be offered to these patients.…”

Section: Discussionmentioning

confidence: 99%

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Hymavathi¹,

Tadisetti²,

Gottipati³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Infertility is a burning problem affecting 10-15% of the couples globally. The female factors contribute to about 40- 45% among which uterine factor is up to 10%. Presence of uterine myomas also significantly contribute to infertility. A conservative surgical approach like myomectomy is indicated for women in reproductive age both for psychological reasons as well as to preserve their reproductive potential. In recent years laparoscopic myomectomy (LM) has become the procedure of choice. Pregnancy outcome after myomectomy is a more significant concern especially with regard to the obstetric calamity of sudden uterine rupture due to the presence of an operative scar. The intensity of such complication will be considerably high when a triplet pregnancy occurs with a LM scar in the upper uterine segment with history of uterine cavity being opened during the myomectomy surgery. Managing such a case will be a difficult task to the attending clinician posing many unexpected clinical dilemmas. We are reporting a unique case of triplet pregnancy occurred following a LM resulting in successful maternal and fetal outcome. During the course of this pregnancy apart from considerable maternal distress due to uterine over distension many clinical problems like cervical insufficiency, pre eclampsia, polyhydraminos, intrauterine growth restriction (IUGR) and last but not the least severe postpartum haemorrhage (PPH) have been encountered and could be managed efficiently. An elective Caesarean section was performed at 33+4 weeks gestation delivering live triplets. Mother and all the three babies discharged from the hospital in good condition.

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Section: Discussionmentioning

confidence: 99%

Successful outcome of a triplet pregnancy following laparoscopic myomectomy for infertility: a unique case report

Hymavathi¹,

Tadisetti²,

Gottipati³

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…3). When the criteria of selection were strictly adhered to and there was no other associated infertility, laparoscopic myomectomy increased implantation rates [17,18].…”

Section: Fertility Outcomementioning

confidence: 99%

Update on laparoscopic myomectomy

et al. 2005

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Our aim was to analyze the indications and factors influencing laparoscopic myomectomy and its outcome. A retrospective analysis was done of 178 patients who underwent laparoscopic myomectomy at the between 2000 and 2003. A detailed history was taken of all patients with uterine fibroids measuring <3->10 cm in diameter. Thirty-seven patients were pretreated with gonadotropin-releasing hormone analogues. Of the 178 patients with myomas, 24% had pedunculated-subserous fibroids, 76% had intramural myomas, and none had diffuse myomatosis. The mean operating time for laparoscopic myomectomy was 90 min, and mean hospital stay was 2±0.5 days. The only complications encountered were in two patients with a small hematoma in the abdominal wall. No late complications were found. Seven of 178 cases required a second laparoscopic myomectomy. A pregnancy rate of over 55% was achieved in the infertility cases, with a 30% cesarean section rate. Postoperative recovery and resumption to normal life were quicker compared with laparotomy with low morbidity. Overall, laparoscopic myomectomies were performed for the following indications: pelvic mass (29%), metrorrhagia (17%), pelvic pain (14%), and infertility (40%). Laparoscopic myomectomy is the technique of choice for pedunculated-subserosal and intramural fibroids in properly selected cases. It requires a skilled endoscopic surgical unit and an efficient team and results in a very low morbidity. Submucous fibroids and diffuse myomatosis were not evaluated in this study.

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“…Le risque de conversion est plus élevé en cas de fibrome de plus de 5 cm [17,18], de localisation intramurale [18,33,34] et de localisation antérieure (la suture étant techniquement plus difficile à réaliser dans cette situation). L'utilisation d'agonistes est pour certain un facteur de risque supplémentaire, le plan de clivage du fibrome étant plus difficile à trouver dans ce cas [17,18].…”

Section: Complications Peropératoires Et Postopératoires Immédiates Runclassified

“…La diminution du risque hémorragique peut être expliquée de deux manières : l'effet du pneumopéritoine peut d'une part, directement agir sur l'hémos-tase, et d'autre part, l'élargissement du champ de visualisation par le coelioscope permet une localisation plus précise des éléments vasculaires à coaguler [20]. Le taux de transfusion varie dans la littérature de 0,3 à 0,9 % [28,32,33]. Les études randomisées comparant la voie coelioscopique et la laparotomie dans le traitement des fibromes montrent une durée d'hospitalisation plus courte, une réduction des douleurs postopératoire, une convalescence moins longue [5,7] et une diminution du risque de fièvre postopératoire [7].…”

Section: Risque Hémorragiqueunclassified