Laparoscopic and Hysteroscopic Myomectomy ( I )
Laparoscopic myomectomy is being applied as an alternative to classical myomectomy. In this technique, myomas of the abdomen may be removed with the help of a camera. There are some other limitations of this technique apart from its difficulty and necessity to have an experience. Laparoscopic surgery which is known as closed surgery in public requires serious surgical experience whatever its purpose is, because the surgeon does the surgery of a 3 dimensional organ by looking to a 2 dimensional tv rather than the normal technique. Experience is more important in laparoscopic myomectomy. The surgeon must know how to apply laparoscopic sutures and do it fast when necessary. Other factors that limit the technique are: number of myomas, size of the uterus and location of myomas. The superiority of laparoscopic myomectomy to open surgery is that patient is a bit more comfortable and hospital stay is shorter. No significant difference was reported between them according to adhesions that occur after the operation.
Another argument about this technique is the claim that during closure of the cavity after removal of myoma, the closure is not being done multiple times but only with one suture, and the uterus gets ruptured during pregnancy, causing severe complications that may result in baby’s death. In a wide review conducted by Parker in 2006 December which was published in Clin. Obstet & Gynecology, it had been emphasized that there were no studies that compare open and closed surgery for uterine rupture until that date. Although there has been two studies published on this subject until then, their patient volumes are limited and they do not prove much academically. On the other hand, Parker reported in the article that there have been 11 reported cases of uterine rupture in pregnancy after laparoscopic myomectomy until 2006, which is a high number. Accordingly, frequency of uterine rupture is lower in open surgery. In the series of Palermo et al. this rate was found to be 76 in 98.872 childbirths and only 1 of them occurred after open myomectomy.
Classical myomectomy in open surgery is the standard method for removal of myomas while preserving the uterus. The important point in laparoscopic myomectomy is the selection of patients. Also, it is obligatory to be honest with the patients and keep them informed about possible complications. I apply laparoscopic myomectomy in selected patients. Thus advantages such as shorter hospital stay, going back to work quicker could be benefited.