The extraction of uterine leiomyoma appears to improve fertility rates and therefore is recommended in selected cases. Dr. Ray Garry presented a view that laparoscopic surgery for leiomyomas will not be accepted unless the significant complications of the laparoscopic approach can be avoided. As he points out, only the best of the best provide the surgical reports in the literature and in the hands of Professor Dubuisson laparoscopic myomectomy is a safe procedure. However, an evidence based surgical practice may not indicate the same results. An example of this is the hemorrhage rate found in the literature found for laparoscopic assisted vaginal hysterectomy, which is 56 per 1,000, whereas for abdominal hysterectomy it is less than 10 and vaginal hysterectomy less than 20 per 1,000.
Ureteric damage is less experts than it is with the average gynecologic laparoscopic surgeons.
The experts may demonstrate safety and efficiency in the performance of laparoscopic myomectomy but the same procedure may not be as effective or safe in the hands of the average laparoscopic surgeon. Dr. Garry pointed out it is essential that complications of entry and exit be avoided as well as complications of the technique. Complications relating to damage to the bowel such as perforation has become the second most common claim against gynecologists in England. The entry technique itself is inherently flawed in that it is a blind procedure and until this procedure can be improved creates an unacceptable risk for the patient. The indications for the procedure are that the individual must wish to retain the uterus and that the fibroid should be palpable and causing symptoms or bleeding and anemia.