Myomectomy as a reproductive procedure

Article Abstract:

Myomectomy is a surgical procedure in which masses inside the muscle wall of the uterus, called uterine myomas, are removed. Myomectomies are being performed instead of hysterectomies (removal of the entire uterus) to maintain the integrity of the uterus in women who want to have children. Additionally, many women prefer myomectomies to hysterectomies because of emotional, psychological or cultural reasons. The reproductive experience of 63 patients undergoing 64 myomectomies is reported. Most of the operations were performed because of an enlarged, nodular uterus. Symptoms warranting a myomectomy were an enlarging uterus, excessive bleeding, anemia, and pregnancy wastage (fetal death). All the women wished to preserve or improve their reproductive potential, although that was not the primary reason for the myomectomy in any of the cases. Thirty-two women had never had children, 10 women had children, and 14 women had a history of spontaneous pregnancy loss. The average age was 35.8 years, and the range was 27 to 47 years. All of the operations were successfully performed and none of the women experienced any excess bleeding requiring a blood transfusion, or any other complication. In three patients, the myomas returned, requiring a repeat myomectomy. Of the 32 patients attempting pregnancy, 16 became pregnant and 12 delivered healthy infants; there were two ectopic pregnancies (pregnancies implanting outside of the uterine cavity) and two spontaneous abortions. There was no relationship between the size of the removed tumor and the ability to achieve a pregnancy. Therefore, myomectomies are successful in maintaining reproductive integrity regardless of uterine size. (Consumer Summary produced by Reliance Medical Information, Inc.)

Uterus, Infertility, Female, Female infertility

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Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome

Article Abstract:

Laparoscopic surgery to remove uterine tumors known as myomas may be as effective as conventional surgery but with less pain and shorter hospitalization during recuperation. Researchers assigned 20 women with uterine myomas to laparoscopy and 20 to laparotomy, or conventional surgery. Patients were 22 to 44 years old. Amount of blood loss and length of operations were similar for laparoscopy and laparotomy. Laparoscopy was associated with less intense pain after surgery, with 17 of 20 laparoscopy patients off of pain killers by the second day after surgery, as opposed to three of 20 laparotomy patients. Eighteen of 20 laparoscopy patients were discharged from the hospital three days after surgery, versus two of the 20 laparotomy patients. Laparoscopy may not be advised for patients with more than four myomas or a myoma larger than six centimeters in diameter.

Evaluation, Laparoscopy

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Cherney versus midline vertical incision for myomectomy or hysterectomy of a significantly enlarged uterus

Article Abstract:

The outcome of patients who undergo surgery to remove large benign tumors of the uterine muscle may not differ according to the type of incision used. Researchers removed large benign uterine tumors from 20 patients using a Cherney incision across the abdomen, and from 20 other patients using vertical incisions. Both incisions were associated with similar numbers of patients with complications. Patients who received vertical incisions, however, experienced more complications, and these were more serious than those in the patients who received a Cherney incision. The reason for this may be that vertical incisions do not expose the deeper areas involved in surgery. The use of the Cherney incision allowed surgeons to use less retraction of the incision site and have greater access to uterine attachments and arteries.

Methods, Gynecology, Operative, Gynecological surgery

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