Laparoscopic Myomectomy

Currently available instruments make laparoscopic myomectomy (fibroid removal) feasible, although the wide application of this approach may be limited by the size and number of fibroids (also commonly mistakenly called fibroid cysts or fibroid tumors) reasonably removed, and the technical difficulty of laparoscopic suturing. However, studies suggest that when performed by experienced laparoscopic surgeons, laparoscopic myomectomy is safe and efficacious. A series of 368 women undergoing laparoscopic myomectomy with removal of 768 fibroids reported a mean operating time of 100 minutes (range 30 to 300). The significant complications were limited to one sigmoid injury that was repaired laparoscopically. In addition, 10 women (2.7%) received cell-saver autologous blood, and 4 required postoperative blood transfusion. Of 332 consecutive women undergoing laparoscopic myomectomy for symptomatic fibroids smaller than 15 cm, 3 required conversion to laparotomy. Another case series showed the feasibility of laparoscopic surgery in women with large fibroids. Laparoscopic myomectomy was performed on 144 women for fibroids ranging from 5 to 18 cm (mean, 7.8 cm), most of which were intramural or submucosal (n=108). Operating time ranged from 58 to 180 minutes with an average of 95 minutes and only 2 (1.4%) women required conversion to laparotomy.

Recent advances in laparoscopic myomectomy include the da Vinci myomectomy, which was not included in this study. Robotic myomectomy offers some advantages over traditional laparoscopic myomectomy, however, a properly trained surgeon should be able to accomplish the same results without the robot.