2676 Laparoscopic Myomectomy: A New Suturing Technique

Study Objective The aim of the present study was to find a surgical technique that allows to perform laparoscopic myomectomy even of large fibroids located in difficultly accessible locations, such as the posterior uterine wall, by reducing both the operative time and the risk of bleeding related to the suture of the uterine wound. Design Prospective case control study, lasting 8 months. Setting Department of Gynecology in Nuona Villa Claudia Clinic, Rome (Italy). Patients or Participants Forty women of reproductive age with an intramural-underserous posterior uterine wall myoma, measuring 6-8 cm, undergoing laparoscopy to remove it. Interventions The 40 women enrolled underwent laparoscopic myomectomy according to the classical technique: transversal incision in the most distended part of the myometrium down to the pseudocapsule, identification of the cleavage plane and enucleation of the myoma. All of the study women had the myometrial wound repaired using an absorbable 2/0 barbed polygliconate wound closure device, but while in 20 of them a single layer continuous suture was performed, starting from the left end of the wound up to the right, in the remaining 20 women a single stitch was initially placed in the central part of the wound and transversal to it. That thread was cut sufficiently long to be grasped with a joanne and lifted upwards, while a single layer semicontinuous suture was performed. Measurements and Main Results The evaluation showed, in group 1 and 2 respectively, an average surgery duration of 55 and 42 minutes and a mean intraoperative blood loss of 1.5 and 0.8 g/dl of hemoglobin. Conclusion The suturing technique proposed in group 2 significantly facilitates the operator work, allowing both a shorter duration of the surgical procedure and a reduction in intraoperative blood loss. It could be, then, a valid alternative to the classic suturing technique, especially in cases of myomectomy of large fibroids of the posterior uterine wall.