Myomectomy: variations and difficult cases
Epublication WebSurg.com, Jun 2012;12(06). URL: http://websurg.com/doi/lt03enzupi001
The aim of this presentation is to demonstrate the rules to avoid difficult situations in laparoscopic myomectomy. Myomectomy is one of the most challenging laparoscopic procedures, and can be time-consuming. Prior to performing a laparoscopic approach, it is always necessary to consider myoma-related factors such as number, location, and size. Regarding the surgeon’s experience, the most frequent problems are related to hemostasis achievement, traction maneuvers to enucleate myoma, and closure of uterine wall defect. Strategy and experience are truly essential to face difficult cases, and alternatives to facilitate the procedure include trocar placement, uterine artery clipping to reduce blood loss, but the most important issue remains appropriate patient selection.