Revolutionizing Myomectomy: A Laparoscopic-Assisted Approach – ARC Summit

In a recent case, we addressed an incisional hernia laparoscopically following a hysterectomy. During the procedure, we noted that the abdomen was not adequately closed, leading to bowel protrusion into the abdominal wall. It’s important to note that the absolute contraindications for laparoscopy are situations that prevent us from creating a pneumoperitoneum; most other scenarios are manageable with the right experience and instruments.

Yesterday, I discussed a technique valuable for reproductive endocrinologists: laparoscopically assisted myomectomy. Consider a patient with numerous fibroids and a desire for fertility. We began with diagnostic laparoscopy, identifying multiple fibroids, including a pedunculated one which we removed by coagulating the base and then excising additional smaller fibroids.

For patients with infertility concerns, it’s widely recognized that having more than three fibroids can complicate fertility. Thus, we utilized a mini laparotomy approach for more extensive removal. Using the Alexis retractor, we exteriorized the uterus through a small incision, allowing for better manipulation and removal of the fibroids. In total, we removed 15 fibroids.

To minimize blood loss, we temporarily ligated the uterine arteries. We located the uterine artery above the ureter, applied clips, and after ensuring all fibroids were addressed, we removed the clips. The procedure significantly reduces blood loss and recovery time compared to traditional methods.

This technique not only ensures thorough treatment but also provides a minimally invasive option for managing complex fibroid cases, enhancing fertility outcomes for patients like the 32-year-old woman in our case. Thank you for the opportunity to share this approach; teaching these techniques also deepens my understanding and practice.