Myomectomy for uterine myomas through ultramini‐laparotomy

Abstract

Uterine fibroids are the most common benign tumors in the female reproductive tract during the reproductive years. Among the options in the treatment spectrum, myomectomy is always considered one of the best choices in the management of women with symptomatic uterine fibroids who wish to preserve future fertility. Myomectomy through conventional exploratory laparotomy may be the most familiar surgical approach. However, with the advances being made in techniques and instruments, there are many alternative approaches to myomectomy, including mini-laparotomy, ultramini-laparotomy, laparoscopy, laparoscopy-aided, and vaginal and hysteroscopic approaches. The focus of this review article is limited to discussing the use of the ultramini-laparotomy approach to completing myomectomy in the management of the uterine fibroids.

Typical and atypical clinical presentation of uterine myomas

“…78e81 Ultra minilaparotomy (UMLT), a new procedure, resulted in a better recovery than conventional laparotomy when treating uncomplicated uterine myomas, but with a similar rate of symptom relief, especially for uterine fibroids less than 8 cm in size and fewer than five in number. 6,32,33 When compared to the laparoscopic approach for UVO procedure (LUVO), the UMLT approach for UVO procedure is also an acceptable option with similar therapeutic outcomes, although LUVO might yield a faster recovery. Since LUVO and UMLT myomectomy combination might require less operation time and achieve a higher success rate, this approach might be a more reasonable choice in the management of symptomatic uterine fibroid than the combination of LUVO and LM.…”

Fertility and Pregnancy Outcome after Myoma Enucleation by Minilaparotomy under Microsurgical Conditions in Pronounced Uterus Myomatosus

“…Advantages of the laparoscopic intervention in comparison to conventional laparotomy are less pain [18,29], lower intraoperative loss of blood [30], mostly shorter operating time in dependence on the original diagnosis, and a lower rate of postoperative adhesions [31]. However, in the case of difficultly accessible or multiple myomas, the operating time can under certain circumstances be longer than that of a conventional laparotomy, so that laparoscopic myoma removal reaches its limits, especially for multiple myomas, complex situations and the patientʼs desire to have children [32][33][34]. The aim of this study is to assess the fertility capability and pregnancy outcome after operative removal of myomas by minilaparotomy in a special patient collective.…”

“…The occurrence of postoperative adhesions after myoma removal and the possible negative impact on fertility (e.g., peritubal adhesions with negative impact on the ovum trapping mechanism) has as yet not been sufficiently evaluated. Laparoscopy reaches it limits in cases with excessively large and multiple myomas with protrusion into the uterine cavity and the danger of cavity opening [32,34,54,67]. In cases with larger myomas, e.g., of the anterior or posterior uterine wall, as well as softened nodes a laparoscopic procedure must not infrequently be converted into a laparotomy [33,36].…”

Vaginal myomectomy is a safe and feasible procedure: A retrospective study of 46 cases

“…Medical treatment can only be administered for the symptoms of fibroids and then only for short periods of time, therefore many patients require surgical treatment. Traditionally, myomectomy has been performed by laparotomy or minilaparotomy, 3 but the advent of endoscopic surgery, including laparoscopic, hysteroscopic and robotic surgery, has introduced a less invasive alternative to preserving the uterus and fertility 4,5 . Vaginal myomectomy of subserous and intramural myomas is a frequently neglected procedure for the removal of myomas via anterior or posterior colpotomy 6–8 …”