Multimedia article. Highly effective method for myoma excision and suturing in laparoscopic myomectomy.

ABSTRACT

BACKGROUND: Laparoscopic myomectomy rather than abdominal myomectomy has been well documented as a treatment option for uterine myomas. However, laparoscopic myomectomy has serious limitations in two of its steps: excision of myoma with strong traction and suturing of the uterine defect. These steps are a challenge even for experienced surgeons. The authors introduce a simple but highly effective technique for excision of myoma and suturing using standard instrumentation in laparoscopic myomectomy. METHODS: After incision of the myometrium, the myoma pseudocapsule is separated by insertion of the dissector tip and scissors into the myoma. After completion of myoma enucleation, the surgeon makes a U-shaped hole of suture material with forceps for an interlocking suture, and the first assistant holds the stitch to maintain the suture tension throughout the repair. RESULTS: From February 2010 to August 2010, 43 patients with a diagnosis of uterine myoma underwent laparoscopic myomectomy by single surgeon using the aforementioned procedure. The mean diameter of the myoma was 6.3 cm (range, 4-9 cm), and multiple myomas were observed in 19 cases (44.2%). As a result, the mean operative time was 75.9 min (range, 35-155 min), and the hospital stay was 2.7 days (range, 2-5 days). The blood loss was 137.2 ml (range, 50-250 ml), and the hemoglobin decline on the first day after surgery was 1.5 mg/dl (range, 0.1-3.6 mg/dl). Postoperative fever higher than 37.7°C was the most commonly observed morbidity (ten patients, 23.3%). How- ever, no cases had conversion to laparotomy or major complications requiring reoperation or readministration during the mean follow-up period of 5.9 months (range, 3-9 months). CONCLUSIONS: Laparoscopic myomectomy can be performed easily and effectively by forceps insertion and continuous interlocking suture using standard instruments.