Elsevier

Journal of Minimally Invasive Gynecology

Volume 19, Issue 6, November–December 2012, Pages 762-767
Journal of Minimally Invasive Gynecology

Clinical Case Review
Report of 7 Uterine Rupture Cases After Laparoscopic Myomectomy: Update of the Literature

https://doi.org/10.1016/j.jmig.2012.07.003Get rights and content

Abstract

The objective of this article is to report 7 previously unpublished uterine rupture cases in pregnancy after laparoscopic myomectomy and to update the medical literature. All cases were reported to the Board of Endoscopic Gynecologic Surgery (Athens, Greece) from 1998 to 2011. Myomas were single in 85.7% of patients, subserosal or pedunculated in 85.7%, and ≤5 cm in 71.4%. Bipolar diathermy was the sole method used for hemostasis in 28.6%, and could be characterized as excessive in 85.7%. A 2-layer closure with stitches of the myometrium was performed in just 14.3% of cases. Mean (SD) time between surgery and pregnancy was 1.4 (0.5) years. Uterine rupture occurred at 34 weeks of gestation or later in 85.7%, and during labor in 14.3% of cases. All women survived. Fetal demise was reported in 1 twin pregnancy (both fetuses) with rupture at 24 weeks of gestation. Laparoscopic myomectomy should be performed by adequately trained and experienced surgeons. Excessive use of diathermy for hemostasis should be avoided, and multiple-layer suturing should always be used for repairing the myometrial defect in cases of intramural and subserosal myomas with deep intrusion.

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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    The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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