Clinical Case ReviewReport of 7 Uterine Rupture Cases After Laparoscopic Myomectomy: Update of the Literature
Section snippets
Materials and Methods
All cases of uterine rupture during pregnancy after laparoscopic myomectomy that were reported to the Board of Endoscopic Gynecologic Surgery (Athens, Greece) from 1998 to 2011 were reviewed. The board consists of surgeon-members of the Hellenic Society of Gynecologic Endoscopy with expertise in endoscopic surgery, and serves as a referral center in Greece. Surgeons responsible for the reported cases were contacted and interviewed. Videos of operations were available for all reported cases, and
Results
Seven patients experienced uterine rupture after laparoscopic myomectomy performed from 1998 to 2009. Reported patient and operative characteristics are given in Table 1. Mean (SD) age of patients at surgery was 34.3 (2.9) years. Maximum diameter of myomas overall was 4.4 (2.1) cm, and in 5 patients (71.4%) was ≤5 cm. Six patients (85.7%) had a single myoma. Only one patient (14.3%) had an intramural myoma; all others had subserosal and/or pedunculated myomas. The initial incision to the uterus
Discussion
Uterine rupture after laparoscopic myomectomy is a serious complication of the procedure, and may lead to extremely unfavorable outcomes including fetal and/or maternal death. In theory, various factors can affect efficient wound healing after myomectomy performed either laparoscopically or at laparotomy. These factors include the method and/or instrumentation used for uterine incision, achievement of hemostasis and closing of the myometrial defect, the extent of tissue damage (which depends on
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