Laparoscopic Myomectomy

Indication

  • The main condition is that the patient desires to preserve her childbearing potential.
    • The main indication is intramural or subserosal fibroids causing serious symptoms (excessive menstrual bleeding, pelvic pain or pressure).

Only the removal of submucosal fibroids has been consistently shown to improve fertility outcomes.

Technique

  • Preoperative antibiotic prophylaxis (single shot, second generation cephalosporine).
  • Patient in lithotomy position.
  • Desinfection of the abdomen, thighs, vulva and vagina.
  • Sterile surgical drapes.
  • Urinary catheter.
  • Examination under anesthesia.
  • Use of an atraumatic uterine manipulator that allows chromopertubation.
  • Change of surgical gloves, start of laparoscopy.
  • Placement of a drainage.
  • Removal of instruments and trocars under direct visualization.
  • Suturing of the skin.

Contraindications

  • Patient not fit for surgery.
  • Patient doesn’t have plans for future pregnancies.
  • Absence of symptoms.

Complications

  • Injury of nearby organs (ureter, bladder, bowel).
  • Bleeding.
  • Thromboembolism.
  • Infection.

Postoperative Management

  • Removal of bladder catheter within the first 24 hours.
  • Early removal of drainage.
  • Routine blood test on 1st postoperative day (Hemoglobin).
  • Early patient discharge (usually 2-3 days).
  • Venous thromboembolism prophylaxis with low molecular weight heparin for 7 days.
  • Contraception for the following 6 months.
  • In case of pregnancy, every patient is given a written recommendation from the operating surgeon concerning the future mode of delivery.

Bibliography

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.