Removing large nodes
The surgeon brings the uterus into the wound, places a temporary tourniquet on the uterine arteries, removes the nodes through one or two incisions, sutures each bed in 2-3 layers and restores the serosa with a continuous suture with minimal trauma; nodes are sent for histology. Direct control allows you to remove a node of any size without morcellation and with a reliable scar. Before the operation, an ultrasound/MRI map of the nodes is drawn up, and in case of anemia, hemoglobin is adjusted. Pregnancy is planned 9–12 months after scar control; management of childbirth - taking into account scars on the uterus.
Indications
- multiple fibroids (more than 4 nodes) and large nodes (more than 8-10 cm) if you want to preserve the uterus;
- intramural nodes, deeply located, deforming the cavity, in case of infertility and miscarriage;
- fibroids with rapid growth, anemia, compression of neighboring organs in women of reproductive age;
- impossibility of laparoscopic myomectomy (size, number, location of nodes, adhesions).
Benefits of Open Myomectomy
For multiple and large fibroids, laparotomy provides what is difficult to achieve laparoscopically: palpation search for all nodes, including small intramural ones, reliable multi-layer hand suture of the bed (important for a durable scar during subsequent pregnancy), control of bleeding and shorter duration of the operation. The uterus is preserved, menstrual and reproductive functions are restored. To reduce blood loss, a tourniquet on the uterine arteries, vasopressin are used, and in case of anemia - preoperative preparation. Recurrence of new nodes within 5 years is 15–25%.
When to choose laparotomy
Open access through a transverse Pfannenstiel incision (along the bikini line) remains the method of choice for very large sizes of the uterus and formations, multiple fibroids with deep nodes, severe adhesions after many operations, suspected malignancy with the need for revision, severe heart and lung diseases in which pneumoperitoneum is undesirable, as well as when laparoscopy is unavailable. Laparotomy gives the surgeon direct control of the tissue and a reliable multi-layer suture on the uterus; the scar after cosmetic suturing is barely noticeable. Recovery is longer than after laparoscopy: hospital stay 3–6 days, exercise limitation 1.5–2 months.
