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Chapter 48 - Myomectomy
from Section 10 - Operative Gynaecology
- By Claire Cardaillac, Edouard Vaucel, Norbert Winer, Anais Mortier, Pauline Gueudry, Vincent Dochez, Thibault Thubert
Edited by Tahir Mahmood, Charles Savona-Ventura, Ioannis Messinis, Sambit Mukhopadhyay
Book:

The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology

Published online:

24 November 2021

Print publication:

02 December 2021, pp 424-431
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Summary

Uterine leiomyomas or fibroids are common benign tumours of the uterus. Myomectomy is performed via laparoscopy, laparotomy or hysteroscopy depending on the location of the myoma, the size and the symptoms. Before myomectomy, the patient must be informed of the risk to undergo conversion of the surgical techniques as well as about myoma recurrence. Administration of a GnRH agonist for 4 months before myomectomy improves pre and postoperative haemoglobin levels and reduces the size of the myoma. In the case of submucosal myomas of FIGO type 0, 1 and 2, which are <4 cm in diameter, hysteroscopic myomectomy is the preferred approach and significantly improves pregnancy rates. The laparoscopic approach is feasible when the number of fibroids is low, and they have a small diameter.