Laparoscopic
myomectomy is one of the best treatment options for women with symptomatic
fibroids who wish to maintain their fertility. Compared with
myomectomy by
laparotomy, the laparoscopic approach is associated with shorter
hospital stay, faster recovery, less
postoperative pain, and reduced adhesion formation. Laparoscopic
myomectomy is technically challenging, and occasionally the procedure needs to be completed by
laparotomy. In this review, I will describe my team's experience with laparoscopic
myomectomy and discuss factors contributing to failure. The most important factors affecting conversion of a laparoscopic
myomectomy to
laparotomy are patient selection and the laparoscopic expertise of the surgeon. Each surgeon should determine his or her criteria for laparoscopic
myomectomy. Other factors include posterior intramural location, soft consistency associated with the use of
gonadotropin releasing hormone agonist (GnRHa), the diameter of the dominant
myoma, and the weight of the
myoma. The use of robot-assisted technology may provide a means to overcome the challenges encountered with enucleation, extraction, and repair that are seen with conventional laparoscopic
myomectomy.