However, a number of women do not wish to have the uterus removed, and therefore, should have the option of myomectomy. In that patient who wishes to continue fertility, myomectomy can be considered either via hysteroscopy or via an abdominal approach depending upon the location of the myomata. Patients who have had a myomectomy who become pregnant may need to consider cesarean delivery at the fetal maturity if a significant defect is encountered. Myolysis can be considered hysteroscopically if appropriate. Simultaneous laparoscopy is recommended for safety and further diagnosis during these hysteroscopic procedures.
Controversy surrounds the methods of abdominal myomectomy.
With current curved needle suturing techniques which have made retropubic suspension and posterior floor defect repair possible, most if not all of these myoma defects may be closed via laparoscopy. Most would agree that if these closures can be accomplished, the documentably lower morbidity associated with laparoscopy would make this the procedure of choice. It is reasonable to assume that with good clinical closure larger intramural myoma can be included in this group. Conclusion Uterine myomas are a frequently seen gynecological malady. Only a fraction of those patients with myomas are candidates for surgical therapy.