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Study Objective: To evaluate the baseline and postoperative changes in quality of life and symptom-severity scores in women undergoing laparoscopic or open abdominal myomectomy for symptomatic myomas., Design: Prospective cohort study of patients choosing myomectomy for symptomatic uterine myomas., Setting: Academic medical center., Patients: A total of 143 women enrolled in the study. Of these, 80 women completed both a preoperative questionnaire and at least 1 postoperative questionnaire between 6 and 27 months after surgery., Interventions: A total of 52 women had open abdominal myomectomy, and 28 had laparoscopic myomectomy between October 2014 and September 2017., Measurements and Main Results: The results of the Uterine Fibroid Symptom and Health-Related Quality-of-Life Questionnaire were compared before and after laparoscopic or open myomectomy. Women undergoing open abdominal myomectomy had larger and more numerous myomas than women undergoing laparoscopic myomectomy. Baseline quality-of-life scores were less adversely affected for women having laparoscopic myomectomy (mean [standard deviation], 57 [24] laparoscopic vs 43 [19] open abdominal, p = .01). However, baseline symptom-severity scores were statistically similar (49 [22] for laparoscopic and 57 [20] for open abdominal, p = .08) approaches. Six to 12 months after surgery, both open abdominal and laparoscopic surgeries provided excellent and similar improvements in symptom-severity and quality of life (postoperative symptoms severity scores, mean [standard deviation], 20 [14] laparoscopic vs 13 [11] open abdominal, p = .24 and quality-of-life scores, mean [standard deviation], 91 [16] laparoscopic vs 88 [17] open abdominal, p = .49). These improvements were sustained for women who returned questionnaires up to 27 months of follow-up., Conclusion: Women with symptomatic myomas have a compromised quality of life, and they experience a similarly dramatic improvement in quality of life and decrease in symptom-severity after both laparoscopic and open abdominal myomectomies., (Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

Case reports for uterine rupture subsequent to laparoscopic myomectomy were reviewed to determine whether common causal factors could be identified. Published cases were identified via electronic searches of PubMed, Google Scholar, and hand searches of references, and unpublished cases were obtained via E-mail queries to the AAGL membership and AAGL Listserve participants. Nineteen cases of uterine rupture after laparoscopic myomectomy were identified. The removed myomas ranged in size from 1 through 11 cm (mean, 4.5 cm). Only 3 cases involved multilayered closure of uterine defects. Electrosurgery was used for hemostasis in all but 2 cases. No plausible contributing factor could be found in one case [corrected]. It seems reasonable for surgeons to adhere to techniques developed for abdominal myomectomy including limited use of electrosurgery and multilayered closure of the myometrium. Nevertheless, individual wound healing characteristics may predispose to uterine rupture., (Copyright © 2010 AAGL. Published by Elsevier Inc. All rights reserved.)

Complications may occur during laparoscopic surgery, even with a skilled surgeon and under ideal circumstances; human error is inevitable. Videotaped procedures from malpractice cases are evaluated to ascertain potential contributing cognitive factors, systems errors, equipment issues, and surgeon training. Situation awareness and principles derived from aviation crew resource management may be adapted to help avoid systems error. The current process of surgical training may need to be reconsidered., (Copyright 2010 Elsevier Inc. All rights reserved.)

Complications may occur during laparoscopic surgery, even with a skilled surgeon and under ideal circumstances, because human error is inevitable. We reviewed videotaped procedures where malpractice was alleged and resolved in court to evaluate potential contributing factors. We evaluated possible sources of complications related to cognitive science, systems error, equipment issues, and surgeon selection and training. The way the human brain's hard-wiring shapes information processing, as well as perceptual learning, can influence the risk of surgical complications. Situation awareness and principles derived from aviation crew resource management may be adapted to help avoid systems error. The current process used to select gynecologic surgeons and the structure of surgical training may need to be reconsidered.

A patient conceived 7 years after undergoing a routine laparoscopic myomectomy of an 11-cm pedunculated myoma. Monopolar modulated current (coagulating) was used for hemostasis, and no suturing was necessary. The pregnancy was uneventful until the 34th week, when pain and contractions signaled uterine rupture. Mother and baby did well after emergency cesarean section. A wide area of adjacent tissue injury after complete hemostasis with monopolar modulated current (coagulating) was felt to be responsible for poor myometrial healing and subsequent rupture.

Most women develop myomas during their lifetimes; however, 80% are asymptomatic. When symptoms are determined to be caused by myomas, a number of management options exist that include "watchful waiting," medical therapy, surgery, or more recently uterine artery embolization and focused ultrasound. Myomectomy, either abdominal or laparoscopic, is an approach particularly suited for those women who wish future fertility. It seems clear that, in well trained and experienced hands, well-selected patients can have myomectomy performed under laparoscopic direction. Very large myomas are not as suitable for the laparoscopic approach, but are amenable to a uterine conserving procedure via laparotomy that is facilitated by a number of preoperative and intraoperative measures aimed to minimize or replace operative blood loss. These techniques should provide selected women a uterine conserving procedure with reduced morbidity.

Laparoscopic hysterectomy was first performed in 1989 and has become one of the procedures that may be offered to women with significant gynecologic symptoms. This article describes alternatives to hysterectomy, indications for laparoscopic hysterectomy, and outcomes and complications of laparoscopic hysterectomy as compared with vaginal and abdominal hysterectomy. Surgical technique for both total and supracervical hysterectomy are described as well as the learning curve, training, and credentialing for these procedures.

The article discusses surgical management for Leiomyomas to preserve uterine and fertility in women. Topics include surgical approaches including myomectomy, hysteroscopy, and laparoscopy, the need for preoperative imaging for a successful minimally invasive procedures, and the role played by robotic technology in improving surgical outcomes.