Myomectomy Techniques
Uterine fibroids are common, and if symptomatic and the uterus is to be conserved for child-bearing, myomectomy is the traditional surgical solution. Myomectomy can be done by a variety of techniques, including by laparotomy (open surgery), laparoscopy, h
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Contents
Abstract
1
Introduction.......................................................................... 115
2
Preparation for Myomectomy............................................ 116
3
Techniques of Myomectomy............................................... 116
4 4.1 4.2 4.3
Open Myomectomy.............................................................. Patient Selection .................................................................... Surgical Technique ................................................................ Operative Complications .......................................................
117 117 117 118
5 5.1 5.2 5.3
Hysteroscopic Myomectomy............................................... Patient Selection .................................................................... Surgical Technique ................................................................ Operative Complications .......................................................
119 119 119 120
6 6.1 6.2 6.3
Laparoscopic Myomectomy................................................ Patient Selection .................................................................... Surgical Technique ................................................................ Operative Complications .......................................................
121 121 121 122
7
Robotic Myomectomy.......................................................... 122
8 8.1 8.2 8.3
Vaginal Myomectomy.......................................................... Patient Selection .................................................................... Surgical Technique ................................................................ Operative Complications .......................................................
9
Conclusion ............................................................................ 123
122 122 123 123
References...................................................................................... 124
A. Magos (&) I. Tsibanakos University Department of Obstetrics and Gynaecology, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK e-mail: [email protected]
Uterine fibroids are common, and if symptomatic and the uterus is to be conserved for child-bearing, myomectomy is the traditional surgical solution. Myomectomy can be done by a variety of techniques, including by laparotomy (open surgery), laparoscopy, hysteroscopy and via the vagina. Each has its indication, and advantages and disadvantages. Open myomectomy is suitable for all cases and remains the only choice when the fibroids are numerous and/or large. Laparoscopic myomectomy is most suited to small to medium sized subserous fibroids but can also be used if the fibroid is intramural. Recently, robotically assisted laparoscopic myomectomy has been introduced into clinical practice, but whether it is cost effective remains to be seen. Hysteroscopic myomectomy is indicated for small intra-cavitary and submucous fibroids. Finally, vaginal myomectomy, widely practised in the nineteenth century
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