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Received Mar 22, 2017; Accepted Feb 4, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Uterine fibroids are a common disorder with an estimated incidence of 20–40% in women during their reproductive years [1, 2]. Myoma diagnosis has been substantially improved in the last decade, mainly due to higher sensitivity and specificity of imaging modalities and improved knowledge about how a myoma alters normal endometrial function. The frequency of myoma varies according to age, inheritance, and possibly body mass index [3]. The fact that more women are seeking childbirth at a later age increases the frequency of infertility due to myoma presence, and reduces the implantation potential. Submucous and intracavitary myomas are usually operated on using hysteroscopy, while subserous myomas are approached with laparoscopy. In comparison, intramural myomas can be operated by hysteroscopy or laparoscopy depending on the size (<4 cm) and surgeon’s experience. The number, size, location, and vascularization of a myoma as well as the experience of the surgeon predict the outcome of the operation and subsequent risk of complications [3].
Recent studies demonstrate that the complications after myomectomy have been increasing in the last decade [4, 5]. This trend can partially be attributed to the shift toward childbearing at a later age. Problems with infertility, as well as progressively larger myomas that are also increasing in number, are more common in this age group. A growing number of gynecologists with unjustified confidence at myoma excision by minimally invasive surgery (MIS) without sufficient training in laparoscopic suturing and electromechanical morcellation might also be attributed to these statistics [6]. In 2002 a meta-analysis reported a similar number of intra- and postoperative complications after gynecological operation performed by laparotomy or by laparoscopy [7]. Another meta-analysis on 6 RCTs with 576 patients comparing laparoscopic versus open myomectomy, demonstrated that laparoscopic myomectomy was associated with faster postoperative recovery by day 15, reduced operative blood loss, diminished postoperative pain, and fewer overall complications. Authors concluded that laparoscopic myomectomy, performed by a specialized surgeon and with more stringently selected patients, is a better choice than open surgery [8].
Injuries may be direct, such as by...