Minimally Invasive Myomectomy

  • Kirsten J. Sasaki
  • Charles E. Miller
Chapter

Abstract

Myomectomies can be performed open, hysteroscopically, laparoscopically, and with the assistance of the robot. Minimally invasive approaches, specifically laparoscopic and robotic, have demonstrated improved operative and perioperative outcomes compared to open myomectomies, with minimal complications.

Keywords

Laparoscopic myomectomy Robotic myomectomy Single-site myomectomy Minimally invasive myomectomy 

References

  1. 1.
    Semm K. New methods of pelviscopy for myomectomy, ovariectomy, tubectomy and adenecetomy. Endoscopy. 1979;11:85–93.CrossRefGoogle Scholar
  2. 2.
    Mais V, Ajossa S, Guerriero S, Mascia M, Solla E, Melis GB. Laparoscopic versus abdominal myomectomy: a prospective, randomized trial to evaluate benefits in early outcome. Am J Obstet Gynecol. 1996;175:654–8.CrossRefGoogle Scholar
  3. 3.
    Seracchioli R, Rossi S, Govoni F, Rossi E, Venturoli S, Bulleti C, et al. Fertility and obstetric outcome after laparoscopic myomectomy of large myomata: a randomized comparison with abdominal myomectomy. Hum Reprod. 2000;15:2663–8.CrossRefGoogle Scholar
  4. 4.
    Seinara P, Arisio R, Decko A, Farina C, Crana F. Laparoscopic myomectomy: indications, surgical technique and complications. Hum Reprod. 1997;12:1927–30.CrossRefGoogle Scholar
  5. 5.
    Bhave Chittawar P, Franik S, Farquhar C. Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2014;(10):CD004638.Google Scholar
  6. 6.
    Rossetti A, Sizzi O, Soranna L, Cucinelli F, Mancuso S, Lanzone A. Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy. Hum Reprod. 2001;16(4):770–4.CrossRefGoogle Scholar
  7. 7.
    Palomba S, Zupi E, Russo T, Falbo A, Marconi D, Tolino A, et al. A multicenter randomized, controlled study comparing laparoscopic versus minilaparotomic myomectomy: short-term outcomes. Fertil Steril. 2007;88:942–51.CrossRefGoogle Scholar
  8. 8.
    Kang JH, Kim WY, Lee KW, Kim KH, Song T. Timing for laparoscopic myomectomy during the menstrual cycle. J Minim Invasive Gynecol. 2015;22:1191–5.CrossRefGoogle Scholar
  9. 9.
    Knol HM, Kemperman RFJ, Kluin-Nelemans HC, Mulder A, Meijer K. Hemostatic variables during normal menstrual cycle. A systematic review. Thromb Haemost. 2012;107:22–9.CrossRefGoogle Scholar
  10. 10.
    Hurst BS, Matthews ML, Marshburn PB. Laparoscopic myomectomy for symptomatic uterine myomas. Fertil Steril. 2005;32:1–23.CrossRefGoogle Scholar
  11. 11.
    Kongnyuy EJ, Wiysonge CS. Interventions to reduce hemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2014;(8):CD005355.Google Scholar
  12. 12.
    Hobo R, Netsu S, Koyasu Y, Tsutsumi O. Bradycardia and cardiac arrest caused by intramyometrial injection of vasopressin during a laparoscopically assisted myomectomy. Obstet Gynecol. 2009;113:484–6.CrossRefGoogle Scholar
  13. 13.
    Nezhat F, Admon D, Nezhat C, Dicorpo J, Nezhat C. Life-threatening hypotension after vasopressin injection during operative laparoscopy, followed by uneventful repeat laparoscopy. J Am Assoc Gynecol Laprosc. 1994;2:83–6.CrossRefGoogle Scholar
  14. 14.
    Song T, Kim MK, Kim M-L, Jung VW, Yun BS, Seong SJ. Use of vasopressin vs epinephrine to reduce haemorrhage during myomectomy: a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2015a;195:177–81.CrossRefGoogle Scholar
  15. 15.
    Song T, Kim T-J, Lee S-H, Kim T-H, Kim W-Y. Laparoendoscopic single-site myomectomy compared with conventional laparoscopic myomectomy: a multicenter, randomized, controlled trial. Feril Steril. 2015b;104:1325–31.CrossRefGoogle Scholar
  16. 16.
    Ostrzenski A. A new laparoscopic myomectomy technique for intramural fibroids penetrating the uterine cavity. Eur J Obstet Gynecol Reprod. 1997;74:189–93.CrossRefGoogle Scholar
  17. 17.
    Dubuisson JB, Malartic C, Jabob S, Chapron C, Rambaud D. Preventive uterine artery occlusion combined with laparoscopic myomectomy: a valid procedure to prevent bleeding. J Gynecol Surg. 2004;20:105–12.CrossRefGoogle Scholar
  18. 18.
    Vercellino G, Erdemoglu E, Joe E, Hopfenmueller W, Holthaus B, Kohler C, et al. Laparoscopic temporary clipping of uterine artery during laparoscopic myomectomy. Arch Gynecol Obstet. 2012;286(5):1181–6.CrossRefGoogle Scholar
  19. 19.
    Litta P, Fantinato S, Calonaci F, Cosmi E, Filippeschi M, Zerbetto I, Petraglia F, Florio P. A randomized controlled study comparing harmonic versus electrosurgery in laparoscopic myomectomy. Fertil Steril. 2010;94:1882–6.CrossRefGoogle Scholar
  20. 20.
    Ou C, Harper A, Liu Y, Rowbotham R. Laparoscopic myomectomy technique. Use of colpotomy and the harmonic scalpel. J Reprod Med. 2002;47:849–53.PubMedGoogle Scholar
  21. 21.
    Hambley R, Hebda P, Abell E, Cohen B, Jegasothy B. Wound healing of skin incision produced by ultrasonically vibrating knife, scalpel, electrosurgery and carbon dioxide laser. J Dermatol Surg Oncol. 1998;12:1213.Google Scholar
  22. 22.
    Amaral JF. Ultrasonic dissection. Endosc Surg Allied Technol. 1994;2:181–5.PubMedGoogle Scholar
  23. 23.
    Parker W, Einarsson J, Istre O, Dubuisson J. Risk factors for uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol. 2010;17:551–4.CrossRefGoogle Scholar
  24. 24.
    Zhang Y, Ma D, Li X, Zhang Q. Role of barbed sutures in repairing uterine wall defects in laparoscopic myomectomy: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2016;23:684–91.CrossRefGoogle Scholar
  25. 25.
    Einarsson J, Chavan N, Suzuki Y, Jonsdottir G, Vellinga T, Greenberg J. Use of bidirectional barbed suture in laparoscopic myomectomy: evaluation of perioperative outcomes, safety and efficacy. J Minim Invasive Gynecol. 2011;18:92–5.CrossRefGoogle Scholar
  26. 26.
    Tulandi T, Einarsson J. The use of barbed suture for laparoscopic hysterectomy and myomectomy: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2014;21(2):210–6.CrossRefGoogle Scholar
  27. 27.
    Angioli R, Plotti F, Montera R, Daminai P, Terranova C, Oronzi I, et al. A new type of absorbable barbed suture for use in laparoscopic myomectomy. Int J Gyn Obstet. 2012;117:220–3.CrossRefGoogle Scholar
  28. 28.
    Alessandri F, Remorgida V, Venturini P, Ferrero S. Unidirectional barbed suture versus continuous suture with intracorporeal knots in laparoscopic myomectomy: a randomized study. J Minim Invasive Gynecol. 2010;17:725–9.CrossRefGoogle Scholar
  29. 29.
    Lee E, Wong F. Small bowel obstruction from barbed suture following laparoscopic myomectomy—a case report. Int J Obstet Gynecol. 2015;16:146–9.Google Scholar
  30. 30.
    Bulletti C, Polli V, Negrini V, Giacomucci E, Flamigni C. Adhesion formation after laparoscopic myomectomy. J Am Assoc Gynecol Laparosc. 1996;3(4):533–6.CrossRefGoogle Scholar
  31. 31.
    Sizzi O, Rossetti A, Malzoni M, Minelli L, La Grotta F, Soranna L, et al. Italian multicenter study on complications of laparoscopic myomectomy. J Minim Invasive Gynecol. 2007;14:453–62.CrossRefGoogle Scholar
  32. 32.
    Saccardi C, Gizzo S, Noventa M, Ancona E, Borhero A, Litta PS. Limits and complications of laparoscopic myomectomy: which are the best predictors? A large cohort single-center experience. Arch Gynecol Obstet. 2014;290:951–6.CrossRefGoogle Scholar
  33. 33.
    Sandberg E, Cohen S, Jansen F, Einarsson J l. Analysis and risk factors for intraoperative conversion of laparoscopic myomectomy. J Minim Invasive Gynecol. 2016;23:352–7.CrossRefGoogle Scholar
  34. 34.
    Iles DA, Ahmad G, Watson A. Adhesions: effects on fertility and prevention. In: Metwally M, Li TC, editors. Reproductive surgery in assisted conception. London: Springer; 2015. p. 153–69.Google Scholar
  35. 35.
    Kumakiri J, Kikuchi I, Kitade M, Kuroda K, Matsuoka S, Tokita S, et al. Evaluation of factors contributing to uterine scar formation after laparoscopic myomectomy. Acta Obstet Gynecol. 2010;89:1078–83.CrossRefGoogle Scholar
  36. 36.
    Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Takeda S. Influencing factors of adhesions development and the efficacy of adhesion-preventing agents in patients undergoing laparoscopic myomectomy as evaluated by second-look laparoscopy. Fertil Steril. 2008;89:1247–53.CrossRefGoogle Scholar
  37. 37.
    Kamel RM. Prevention of postoperative peritoneal adhesions. Eur J Obstet Gynecol. 2010;150:111–8.CrossRefGoogle Scholar
  38. 38.
    Ahmad G, Mackie FL, Iles DA, O’Flynn A, Dias S, Metwally M, et al. Fluid and pharmacological agents for adhesion prevention after gynaecological surgery (review). Cochrane Database Syst Rev. 2014;(7):CD001298.Google Scholar
  39. 39.
    Ahmad G, O’Flynn H, Hindocha A, Watson A. Barrier agents for adhesion prevention after gynaecological surgery (review). Cochrane Database Syst Rev. 2015;(4):CD000475.Google Scholar
  40. 40.
    Liu C, Lu Q, Zhang Z, Xue M, Zhang Y, Zhang Y, et al. A randomized controlled trial on the efficacy and safety of a new crosslinked hyaluronan gel in reducing adhesions after gynecologic laparoscopic surgeries. J Minim Invasive Gynecol. 2015;22:853–63.CrossRefGoogle Scholar
  41. 41.
    Fagotti A, Bottoni C, Vizzielli G, Alletti S, Scambia G, Marana E, et al. Postoperative pain after conventional laparoscopy and laparoendoscopic single site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril. 2011;96:255–9.CrossRefGoogle Scholar
  42. 42.
    Yim G, Jung Y, Paek J, Lee S, Kwon H, Nam E, Kim S, Kim J, Kim Y, Kim S. Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol. 2010;203:26.e1–6.CrossRefGoogle Scholar
  43. 43.
    Jung Y, Lee M, Yim G, Lee S, Paek J, Kwon H, Nam E, Kim S, Kim Y. A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain. Surg Endosc. 2011;25:2462–9.CrossRefGoogle Scholar
  44. 44.
    Kim S, Baek J, Park E, Jeung I, Choi J, Kim C, et al. A comparison of single-, two-, and three- port laparoscopic myomectomy. J Soc Laparoendosc Surg. 2015;19(4):e2015.00084.CrossRefGoogle Scholar
  45. 45.
    Nash K, Feinglass J, Zei C, Lu G, Mengesha B, Lewicky-Gaupp B, et al. Robotic-assisted laparoscopic myomectomy vs. abdominal myomectomy: a comparative analysis of surgical outcomes and costs. Arch Gynecol Obstet. 2012;285:435–40.CrossRefGoogle Scholar
  46. 46.
    Ascher-Walsh C, Capes T. Robot-assisted laparoscopic myomectomy is an improvement over laparotomy in women with a limited number of myomas. J Minim Invasive Gynecol. 2010;17:306–10.CrossRefGoogle Scholar
  47. 47.
    Barakat EE, Bedaiwy MA, Zimberg S, Nutter B, Nosseir M, Falcone T. Robotic-assisted, laparoscopic and abdominal myomectomy: a comparison of surgical outcomes. Obstet Gynecol. 2011;117:256–65.CrossRefGoogle Scholar
  48. 48.
    Gobern J, Rosemeyer C, Barter J, Steren A. Comparison of robotic, laparoscopic, and abdominal myomectomy in a community hospital. J Soc Laparoendosc Surg. 2013;17:116–20.CrossRefGoogle Scholar
  49. 49.
    Bedient CE, Magrina JF, Noble BN, Kho R. Comparison of robotic and laparoscopic myomectomy. Am J Obstet Gynecol. 2009;201:566.e1–5.CrossRefGoogle Scholar
  50. 50.
    Gargiulo A, Srouji S, Missmer S, Correia K, Vellinga T, Einarsson J. Robot-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy. Obstet Gynecol. 2012;120:284–91.CrossRefGoogle Scholar
  51. 51.
    Nezhat C, Lavie O, Hsu S, Watson J, Barnett O, Lemyre M. Robotic-assisted laparoscopic myomectomy compared with standard laparoscopic myomectomy—a retrospective matched control study. Fertil Steril. 2009;91:556–9.CrossRefGoogle Scholar
  52. 52.
    Pluchino N, Litta P, Freschi L, Russo M, Simi G, Santoro A, et al. Comparison of the initial surgical experience with robotic and laparoscopic myomectomy. Int J Med Rob Comput Assisted Surg. 2014;10:208–12.CrossRefGoogle Scholar
  53. 53.
    Sasaki KJ, Steller CJ, Sulo S, Cholkeri-Singh A, Miller CE. Comparison of operative and peri-operative results for robotic and laparoscopic myomectomies. J Minim Invasive Gynecol. 2015;22(6):S7.CrossRefGoogle Scholar
  54. 54.
    Goçmen A, Sanhkan F, Mustafa G. Comparison of robotic-assisted laparoscopic myomectomy outcomes with laparoscopic myomectomy. Arch Gynecol Obstet. 2013;287:91–6.CrossRefGoogle Scholar
  55. 55.
    Hsiao S, Lin H, Peng F, Jen P, Hsiao C, Tu F. Comparison of robot-assisted laparoscopic myomectomy and traditional laparoscopic myomectomy. J Obstet Gynaecol Res. 2013;39(5):1024–9.CrossRefGoogle Scholar
  56. 56.
    Pundir J, Pundir V, Walavalkar R, Omanwa K, Lancaster G, Kayani S. Robotic-assisted laparoscopic vs. abdominal and laparoscopic myomectomy: systematic review and meta-analysis. J Minim Invasive Gynecol. 2013;20:335–45.CrossRefGoogle Scholar
  57. 57.
    Lewis E, Srouji S, Gargiulo A. Robotic single-site myomectomy: initial report and technique. Fertil Steril. 2015;103:1370–7.CrossRefGoogle Scholar
  58. 58.
    US Food and Drug Administration. Laparoscopic uterine power morcellation in Hysterectomy and Myomectomy:FDA Safety Communicatino. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm393576.htm. Published April 17, 2014. Accessed July 1, 2017.
  59. 59.
    Serur E, Lakhi N. Laparoscopic hysterectomy with manual morcellation of the uterus. Am J Obstet Gynecol. 2011;204:566.e1–2.CrossRefGoogle Scholar
  60. 60.
    Seidman DS, Nezhat CH, Nezhat F, Nezhat C. The role of laparoscopic-assisted myomectomy (LAM). J Soc Laparoendosc Surg. 2001;5(4):299–303.Google Scholar
  61. 61.
    Dubuisson JB, Chapron C, Levy L. Difficulties and complications of laparoscopic myomectomy. J Gynecol Surg. 1996;12:159–65.CrossRefGoogle Scholar
  62. 62.
    Cohen S, Einarsson J, Wang K, Brown D, Boruta D, Scheib S, et al. Contained power morcellation within an insufflated isolation bag. Obstet Gynecol. 2014;124:491–7.CrossRefGoogle Scholar
  63. 63.
    Steller CJ, Miller CE, Cholkeri-Singh A, Sasaki KJ. Review and outcomes of power morcellation using an innovative contained bag system. J Minim Invasive Gynecol. 2015;22(6):S100–1.CrossRefGoogle Scholar
  64. 64.
    Pritts E, Parker W, Olive D. Fibroids and infertility: an updated systematic review of the evidence. Fertil Steril. 2009;91:1215–23.CrossRefGoogle Scholar
  65. 65.
    Sunkara S, Khairy M, El-Toukhy T, Khalaf Y, Coomarasamy A. The effect of intramural fibroids without uterine cavity involvement on the outcome of IVF treatment: a systematic review and meta-analysis. Hum Reprod. 2010;25(2):418–29.CrossRefGoogle Scholar
  66. 66.
    Jin C, Hu Y, Chen X, Zheng F, Lin F, Zhou K, et al. Laparoscopic versus open myomectomy—a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2009;145:14–21.CrossRefGoogle Scholar
  67. 67.
    Falcone T, Parker W. Surgical management of leiomyomas for fertility or uterine preservation. Obstet Gynecol. 2013;121:856–68.CrossRefGoogle Scholar
  68. 68.
    Tsuji S, Takahashi K, Imaoka I, Sugimura K, Miyazaki K, Noda Y. MRI evaluation of the uterine structure after myomectomy. Gynecol Obstet Investig. 2006;61:106–10.CrossRefGoogle Scholar
  69. 69.
    Koo Y, Lee J, Lee Y, Kwak D, Lee I, Lim K, et al. Pregnancy outcomes and risk factors for uterine rupture after laparoscopic myomectomy: a single-center experience and literature review. J Minim Invasive Gynecol. 2015;22:1022–8.CrossRefGoogle Scholar
  70. 70.
    Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, Venturoli S. Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril. 2006;86:159–65.CrossRefGoogle Scholar
  71. 71.
    Stringer N, Strassner H, Lawson L, Oldham L, Estes C, Edwards M, Stringer E. Pregnancy outcomes after laparoscopic myomectomy with ultrasonic energy and laparoscopic suturing of the endometrial cavity. J Minim Invasive Gynecol. 2001;8:129–36.Google Scholar
  72. 72.
    Lieng M, Istre O, Langebrekke A. Uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol. 2004;11:92–3.Google Scholar
  73. 73.
    Oktem O, Gokaslan H, Durmusoglu F. Spontaneous uterine rupture in pregnancy 8 years after laparoscopic myomectomy. J Minim Invasive Gynecol. 2001;8(4):618–9.Google Scholar
  74. 74.
    Pelosi MA, Pelosi MA. Spontaneous uterine rupture at thirty-three weeks subsequent to previous superficial laparoscopic myomectomy. Am J Obstet Gynecol. 1997;177:1547–9.CrossRefGoogle Scholar
  75. 75.
    Pistofidis G, Makrakis E, Balinakos P, Dimitriou E, Bardis N, Anaf V. Report of 7 uterine rupture cases after laparoscopic myomectomy: update of the literature. J Minim Invasive Gynecol. 2012;19:762–7.CrossRefGoogle Scholar
  76. 76.
    Flyckt R, Falcone T. Editorial: Uterine rupture after laparoscopic myomectomy. J Minim Invasive Gynecol. 2015;22:921–2.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kirsten J. Sasaki
    • 1
    • 2
  • Charles E. Miller
    • 1
    • 2
  1. 1.The Advanced Gynecologic Surgery InstituteNapervilleUSA
  2. 2.Department of Obstetrics and GynecologyLutheran General HospitalNapervilleUSA

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