Principles and techniques of laparoscopic myomectomy

Abstract

Uterine fibroids are found by ultrasound in about 70-80 % of women by the time of the menopause. A large proportion of fibroids are asymptomatic and are usually discovered incidentally during clinical examination or ultrasonography for other indications or during pelvic surgery. However, some women experience significant symptoms due to fibroids such as abnormal uterine bleeding (AUB), pressure symptoms, pain and infertility. In addition to reduced fertility, fibroids may also be associated with adverse pregnancy outcome such as miscarriage and fetal malpresentation. There is also the ongoing debate as to whether fibroids affect the outcome of fertility treatment, particularly the outcome of assisted reproductive technology (ART). Whilst fibroid removal has a clear role in the treatment of bleeding and pressure symptoms, the role of surgery in improving reproductive outcome is less certain.