Total Laparoscopic Myomectomy: Application for Uterine Submucosal Myoma

Abstract

Background: Submucosal myoma has been treated with hysteroscopic transcervical resection (TCR) . However, in cases of unstalked submucosal myoma over 3cm in diameter, TCR could lead to not only extended operation time but also extensive thermal damage on endometrium by electrocoagulation. In this study, we validated the feasibility and utility of total Laparoscopic approach for submucosal myoma treatment.
Materials and Methods: Total laparoscopic myomectomy (TLM) was performed on 12 women with submucosal myoma. Our TLM procedure was as follows: a balloon catheter was detained in the uterine cavity to evaluate the degree of submucosal projection by sonohysterography. Culdotomy was performed to set acrylic vaginal pipe into intraperitoneal cavity as a larger access port. After intramyometrial injection of vasopressin, a transverse incision was made to extract myomas. As myomectomy progressed, endometrium filled with indigocarmine through a detained balloon catheter appeared transparent-blue bulge, which helped easy recognition of endometrial injury. Uterine wall was sutured layer by layer without tucking the endometrium into myometrium. The enucleated nodules were removed via a vaginal pipe.
Results: The median size of dominant submucosal myomas was 5cm, the median blood loss was 120ml and the median operating time was 162 minutes. There was no correlation between the degree of submucosal projection and endometrial defect. Minimal endometrial damage was observed and one of 3 infertile patients was pregnant after surgery.
Conclusion: TLM was feasible in the cases of submucosal myoma as well as intramural and subserosal myomas.