Laparoscopy or laparotomy as the way of entrance in myoma enucleation

Abstract

The design of our work is a systematic literature review of existing studies, reviews, and meta-analysis conducted in PubMed and Cochrane Library to identify relevant literature. Commonly, the myomectomy is to be recommended in women desiring to preserve fertility when myomas are associated with symptoms such as excessive bleeding, pelvic discomfort, or palpable abdominally fibroids. The decision of surgical approach for myomectomy should be individualized, depending on size and location, as well as on surgeon's experience. The different modalities of myomectomy, laparoscopic, hysteroscopic, robotic-assisted, or laparotomic are in detail presented in the paper, according to Society of Obstetricians and Gynecologists of Canada (SOGC) clinical practice guidelines and taking into consideration possible concerns of myomectomy such as uterine rupture, development of adhesions, and myomas' recurrence.

What Is the Role of Barbed Suture in Laparoscopic Myomectomy? A Meta-Analysis and Pregnancy Outcome Evaluation

“…The management of myomas concerns the following aspects: number, size, location, surgical experience, age of patient, and the desire of future pregnancy. There are several surgical procedures to perform the myomectomy: laparoscopy, hysteroscopy, robotic-assisted laparoscopy, and laparotomy [4]. Hysteroscopic miomectomy is an effective technique for the management of submucous myomas; in particular, hysteroscopic morcellation, by reducing the total operative time, operative complications, postoperative adhesions, and increasing patient’s satisfaction [5].…”

Modern Myoma Treatment in the Last 20 Years: A Review of the Literature

“…Is there an upper limit for number of fibroids removed in laparoscopic myomectomy? Most surgeons would consider laparotomy when more than five fibroids are involved; however, the final decision depends on surgeon preference, site of the myomas, and patient desire to avoid laparotomy [ 29 ]. Which suture technique is superior: extracorporeal or intracorporeal.…”

Regarding “Laparoscopic Radiofrequency Ablation of Uterine Leiomyomas: Clinical Outcomes during Early Adoption into Surgical Practice”

“…Minimal-access myomectomy is overall considered as the gold standard in symptomatic fibroma [1]. To continually reduce invasiveness for patient care, and at the same time avoid the ensuing morcellation problem, new transabdominal laparoscopic and transcervical hysteroscopic treatment options have emerged.…”