Abdominal myomectomy

Myomectomy through the uterine cervix using forceps under sonographic guidance

OBJECTIVES

To evaluate the feasibility of a novel method of forceps myomectomy under sonographic guidance.

METHODS

Between June 2005 and August 2006, we performed a prospective study to evaluate the feasibility of forceps myomectomy under sonographic guidance in patients with submucosal myomas. Patients were enrolled into the study if, on transvaginal sonographic or hysteroscopic examination, their myomas were found to have an intramural extension < 75%, absence of 'sinking' and a mean diameter < 8 cm.

RESULTS

There were 28 patients with submucosal myomas including Types 0 (n = 18), 1 (n = 6) and 2 (n = 4). In 26/28 (92.8%; 95% CI, 82.6-100) patients the myomas were removed completely. The mean operating time and intraoperative blood loss were 27.3 min and 33.5 mL, respectively. The median follow-up time was 15 months. There were no perioperative complications. No patient subsequently underwent myomectomy or hysterectomy.

CONCLUSIONS

In our experience, this novel method of forceps myomectomy is feasible for the removal of Type 0 and Type 1 submucosal myomas as well as selected Type 2 myomas.

Risk of recurrence after myomectomy

The risk of recurrence of uterine myomas was analyzed in 622 patients who underwent myomectomy between 1970 and 1984 at the First Department of Obstetrics and Gynecology of the University of Milan. The cumulative 10-year recurrence rate was 27%, and this increased steadily up to the end of the observation period. Differences were not observed in frequency of recurrence by age at diagnoses or by the site of the myomas at surgery. Patients with a single myoma tended to experience a lower rate, but this finding was not statistically significant. Women who gave birth to a child after myomectomy had a 10-year recurrence rate of 15%, against 30% for those who did not; this difference was statistically significant.

Submucosal leiomyomas and infertility

Seventeen patients with primary (59%) or secondary (41%) infertility and evidence of at least 1 large (greater than or equal to 5 cm) submucosal leiomyoma underwent abdominal myomectomy . In all patients, no other cause of infertility could be found. Following surgery, 2 of the 17 patients elected to use contraception. Thirteen of the 15 patients wishing to establish a pregnancy had 10 or more months of sexual exposure. The overall pregnancy rate was 47%, and 53% of those patients attempting to establish a pregnancy conceived. The corrected pregnancy rate for those with adequate sexual exposure for at least 10 months was 61.5%. Of those women who attained a pregnancy, 63% did so within 11 months after surgery. Only one patient conceived after more than 3 years (38 months). These results suggest that submucosal leiomyomas are a possible cause of infertility and are highly amenable to surgical treatment and subsequent restoration of fertility.

Myomectomy in infertile Jamaican women

One hundred nineteen Jamaican women who underwent myomectomy from 1964 to 1969 were followed up for 5 to 9 years. Infertility was the most common presenting complaint. Preoperative hysterosalpingograms were performed on 61 patients and were abnormal for the majority of these patients. Surgery revealed submucous fibroids in 41 patients and pelvic inflammatory disease in 51 patients. The pregnancy rate following myomectomy was 18.5%, but successful outcomes occurred in only 9.2% of the cases. Pregnancy was unsuccessful for all patients who underwent both myomectomy and tuboplasty. Twenty-three patients had a recurrence of myoma, and 13 of these underwent subsequent hysterectomy.