European Society for Gynaecological Endoscopy (ESGE) Good Practice Recommendations on surgical techniques for removal of fibroids: part 1 abdominal (laparoscopic and open) myomectomy

Abstract

Uterine fibroids are the most common benign tumours of the female reproductive tract and can cause a range of symptoms including abnormal uterine bleeding, pain, pressure symptoms and subfertility. Surgery may be required for some symptomatic fibroids via abdominal or transvaginal routes. The European Society for Gynaecological Endoscopy Uterine Fibroids Working Group developed recommendations based on the best available evidence and expert opinion for the surgical treatment of uterine fibroids. In this first part of the recommendations, abdominal approaches to surgical treatment of fibroids including laparoscopic, robot- assisted and open myomectomy are described.

Figure 1

Surgical steps for laparoscopic removal of a large posterior wall fibroid. Figure 1A. A 9 cm fibroid protruding outwards on the posterior wall described as intramural by MRI.

Figure 1B

The incision over the fibroid to reach the fibroid before extending it to the desired length.

Figure 1C

Removed fibroid.

Figure 1D

Uterine myometrial defect after fibroid removal.

Figure 1E

The first layer myometrial repair completed.

Figure 1F

Second layer myometrial repair completed.

Figure 1G

Serosal closure.

Figure 1H

Second layer myometrial repair completed. G. Serosal closure. H. Incision and exposed barbed suture covered with a sheet of oxidised regenerated cellulose. (Pictures courtesy of Professor E. Saridogan)