Laparoscopic myomectomy has recently gained wide acceptance. However, this procedure remains technically highly demanding and concerns have been raised regarding the prolonged time of anesthesia, increased blood loss, and possibly a higher risk of postoperative adhesion formation. Laparoscopic-assisted myomectomy (LAM) is advocated as a technique that may lessen these concerns regarding laparoscopic myomectomy while retaining the benefits of laparoscopic surgery, namely, short hospital stay, lower costs, and rapid recovery. By decreasing the technical demands, and thereby the operative time, LAM may be more widely offered to patients.
In carefully selected cases, LAM is a safe and efficient alternative to both laparoscopic myomectomy and myomectomy by laparotomy. These cases include patients with numerous large or deep intramural myomas. LAM allows easier repair of the uterus and rapid morcellation of the myomas. In women who desire a future pregnancy, LAM may be a better approach because it allows meticulous suturing of the uterine defect in layers and thereby eliminates excessive electrocoagulation.
To date, no clear recommendation or consensus has been reached about the surgical approach to myomectomy, and no evidence-based data are available for minilaparotomy. On the other hand, the Food and Drug Administration published on the web a safety communication about the use of laparoscopic uterine power morcellation in hysterectomy and myomectomy (www.fda.gov/medicaldevices/ safety/alertsandnotices/ucm393576.htm). This bulletin underlines the risk of spreading unsuspected cancerous tissue, especially for sarcoma, within the abdomen and the pelvis with the use of laparoscopic uterine power morcellators, and discourages their use in case of uterine leiomyomas. In addition, many alterative surgical treatments for managing uterine leiomyomas, including minilaparotomy, are proposed and recommended to healthcare providers, suggesting that, in the next years, more and more laparoscopic myomectomies will be completed, removing the leiomyomas through minilaparotomy (or colpotomy). Although consensus has been reached that myomectomy should be carried out through a minimally invasive surgical procedure, data in literature demonstrated a lack of scientific evidence about the best surgical procedure in terms of preservation of reproductive potential. Therefore, we strongly believe that there is a need for studies that assess the conception and fertility rates after miomectomy.