Myometrectomy in large uterine myomas size

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.