Prevention and Management of Complications in Laparoscopic Myomectomy

Abstract

Myomectomy aims to preserve fertility, treat abnormal uterine bleeding, and alleviate pain. It should cause minimal damage to the endometrium, while being tolerable and durable, and reduce the incidence of myoma recurrence and complications including bleeding, hematoma, adhesions, and gravid uterus perforation. Training and experience are crucial to reduce complications. The surgical strategy depends on imaging information on the myomas. The position of the optical and secondary ports will determine the degree of ergonomic surgery performance, time and difficulty of myoma enucleation, and the suturing quality. Appropriate hysterotomy length relative to myoma size can decrease bleeding, coagulation, and suturing times. Bipolar coagulation of large vessels, while avoiding carbonization and myometrium gaps after suturing, may decrease the risk of myometrial hematoma. Quality surgery and the use of antiadhesive barriers may reduce the risk of postoperative adhesions. Slow rotation of the beveled morcellator and good control of the bag could reduce de novo myoma and endometriosis. Low intra-abdominal CO2 pressure may reduce the risk of benign and malignant cell dissemination. The benefits a patient gains from laparoscopic myomectomy are greater than the complication risks of laparoscopic morcellation. Recent publications on laparoscopic myomectomies demonstrate reduced hospitalization stays, postoperative pain, blood loss, and recovery compared to open surgery.

Clinical Value of Body Mass Index and Waist-Hip Ratio in Clinicopathological Characteristics and Prognosis of Uterine Leiomyomata

“…The prognosis of UL resection mainly considers the healing of the surgical incision and tumor recurrence. In obesity patients, the sutures of the surgical incision are easy to fall off because of the abdomen adipose tissue, and the incision is not easy to heal because of the poor blood circulation of the abdominal adipose tissue [ 24 ]. At the same time, obesity patients often have abnormal blood lipid metabolism, and surgical incisions are susceptible to infection, which affects the prognosis of patients [ 25 , 26 ].…”

Uterine Fibroids in Black Women: A Race-Stratified Subgroup Analysis of Treatment Outcomes After Laparoscopic Radiofrequency Ablation

“…27 This analysis builds on past publications by confirming the outcomes for LAP-RFA, including less intraoperative blood loss, fewer serious adverse events, fewer complications, and fewer missed days of work when compared with published outcomes for myomectomy or hysterectomy. 1,9,[28][29][30][31][32][33][34][35] Furthermore, based on this subgroup analysis, LAP-RFA resulted in equivalent safety…”

Laparoscopic myomectomy in the treatment of large myomas – unnecessary risk or effective method?

“…Six death occurred 31 . Overall, the frequency of injuries to the organs caused by power morcellator was assessed as (0.12%) 32 . Undoubtedly, LM has many advantages when compared to laparotomy.…”