Abstract
Because of later marriage and postponement of childbearing, the number of fibroid cases being treated via uterine preservation procedures is increasing. Although the available choices for uterine preservation are increasing (i.e., gonadotropin releasing hormone analogs, uterine artery embolization, and focused ultrasound ablation), a myomectomy is the only well-established procedure for preservation of fertility. In order to decrease blood loss and ensure safety during a myomectomy, the most important element is prompt suturing of the myometrium. However, when we perform a laparoscopic myomectomy, several restrictions make suturing difficult (i.e., needle direction, suturing speed, and visibility of the lower wound margin). Therefore, it is necessary to carefully choose the suturing method.
We consider that the best suturing method should be one with less tissue handling, decreased number of sutures and knots, and excellent tissue approximation. Although the Smead-Jones suture is one of the suturing methods used on abdominal fascia with a midline incision, we have applied this suturing method to restore the myometrium. The Smead-Jones suture does not require the backward manupulation of the needle as used in the mattress or baseball suture. Therefore, under a laparoscopic surgery, this suture facilitates needle handling. Furthermore, by suturing all layers, the Smead-Jones suture decreases the number of knots; furthermore, excellent tissue approximation without wound tension and dead spaces can be achieved. One note of caution: when a Smead-Jones suture is used to restore the myometrium, we should apply adhesion barriers to the wound, because of the increased amount of exposure of the stitches on the serosa. Further studies are needed to determine whether using of the Smead- Jones suture contributes the prevention from thinning of the uterine wound.
