Laparoscopic myomectomy and myolysis.

The indications for operative laparoscopy have expanded greatly over the past decade as its many advantages over laparotomy have become recognized. Laparoscopic myomectomy as a technique is now clearly described. A monopolar hook is used for the uterine incision. After atraumatic enucleation of the myoma, the myometrium and serosa are usually sutured, especially if the incision is deep or more than 2 cm long. Myomas can be removed by posterior colpotomy. However, the development of an electrical cutting device permits easier and quicker removal of the myoma through the suprapubic puncture site. Only complicated myomas or those which give rise to persistent symptoms despite properly prescribed medical treatment, together with those which grow rapidly, require surgery. These satisfactory preliminary results must not mask the fact that laparoscopic myomectomy is lengthy and difficult, reserved for experienced surgeons with a thorough familiarity with endoscopic sutures. Under these conditions, laparoscopic myomectomy is possible, even for large myomas (5 cm and over) located purely intramurally. However, there are limits, and it is preferable to schedule myomas measuring over 8 cm and multiple myomectomy (over two) for laparotomy. Although the preliminary results are encouraging, the risk of adhesiogenesis on the uterine scar, the quality of the uterine suture and the fertility results need to be assessed in the near future.