Abstract:
Introduction: Surgical interventions for very large uterine myomas (hysterectomy vs organ
preserving procedure) are under evaluation. The aim of the study was to analyze one center
experience of myometrectomy in surgical treatment of very large uterine myomas. Material and
methods: From November 1994 to May 2008, 21 consecutive patients with very large uterine
myomas (?16 weeks, according criteria published by West S. at all., 2006) were selected for organ preserving operation (myometrectomy). The mean age of patients was 36.48 ± 0.72 (ranged from 31
to 43 years). Tumors size was 17.81 ± 0.9 (range from 16 to 35 weeks). Operative technique includes:
(1) temporary vascular clamp of uterine vessels; (2) two "V" incisions of the anterior and posterior
uterine wall ("ellipse type"), with subtotal removing of myometrium with all myomas nodules and
maximum preserving of the endometrium volume; (3) formation of new endometrial cavity; (4) final
formation of “neo-uterus” with vascularize perimetrium flaps used continuous “baseballs” sutures
("Vicryl" or "PDS" Ethicon®). For final hemostasis were used non-commercial fibrin glue and
human thrombin (27 vs 17 cases). Results: The mean operation time was in the range of 45 to 147
min (mean 79.52 ? 5.5). Blood loss was 298.43 ± 20.8 ml. Number of nodules excision were from 1
to 11 (mean ± SD, 4.05 ± 0.7). The mean hospital stay was 6 - 8 days. Conclusion: Conventional
abdominal myometrectomy is safe, favorable and effective procedure in surgical treatment of
voluminous myomas with accessibly morbidity and recurrence rate.
