Laparoscopic Myomectomy for Infertile Patients with Intramural Fibroids: A Retrospective Study at a Tertiary Endoscopic Centre (Original Article) (Report‪)‬

Uterine fibroids are the most common solid pelvic tumours in females. Fibroids have a reported incidence ranging from 30% to 70% in women of reproductive age and increasing with age. (1) A large percentage of fibroids are undiagnosed, since many are asymptomatic. The real incidence of fibroids is therefore unknown. The peak incidence is between 35 and 49 years. (1) Black women are 3-9 times more likely to suffer from uterine fibroids compared with European ethnic groups. (2) Risk factors for fibroids include nulliparity, obesity, black ethnic group, family history, polycystic ovarian syndrome, diabetes and hypertension. (3,4) Patients with uterine fibroids usually present with excessive or irregular vaginal bleeding, infertility or pain. There is no clear evidence on whether it is safer to remove intramural fibroids by laparoscopy or by laparotomy. One of the biggest case series on the safety of laparoscopic myomectomy studied 265 women who underwent laparoscopic myomectomy. In that series subserosal and intramural fibroids were removed, with a conversion rate of 11.3% from laparoscopy to laparotomy. (5) A meta-analysis of laparoscopic versus open myomectomy overall found fewer complications in the laparoscopic group. No clear distinction was made between subserosal and intramural fibroids. (6) With the new and rapid development in laparoscopic surgery equipment and skills, the question is asked why so many myomectomies are still done as an open procedure. The most likely answer is a lack in surgical skill.