Laparoscopic-assisted myomectomy

Myomectomies are increasingly being performed by a minimal access route. However, laparoscopic myomectomy remains a technical challenge, especially when the fibroid burden is high because of either a very large myoma or the presence of multiple myomas. These technically difficult cases increase the operating time which in turn increases blood loss, suboptimal uterine reconstruction, and length of stay in hospitals. Laparoscopic-assisted myomectomy addresses all of these difficulties, making myomectomy a quick and feasible method for large and multiple fibroids. Since this surgery involves morcellation by knife, large myomas can be removed safely and swiftly. Uterine reconstruction is carried out in multiple layers with the aid of open surgical instruments. Suturing is simple and easy. Length of hospital stay and overall recovery are similar to those of total laparoscopic myomectomy. One can avoid open myomectomy even in patients with large and multiple fibroids. This chapter describes the stepwise technique and the outcome of 50 cases that underwent this procedure at our unit at Apollo Hospitals in Hyderabad, India.