Concepts and Thoughts about Modern Uterine Intramural and Subserosal Myomectomy

Abstract

Myomectomy is the main conservative uterine operation of modern gynecology, as the percentage of patient with myomas is ever increasing. In the last century, this operation was performed by “open†technique, then, with the advent of minimally invasive technologies, it is passed to the endoscopic method. Thus, hysteroscopy and laparoscopy, until the modern robotically assisted surgery were introduced or the removal of uterine myomas. Many of the concepts of traditional surgery, in light of modern scientific evidences, were revisited, since the myomectomy have been evaluated from the morphological-functional side. Therefore, with the forthcoming endocrinal biological discoveries, myomectomy has slowly changed the technical and surgical planning. Many limits have been widely surpassed, up to the possibility of applying this method even in older women, over 45 in which is critical of the uterus preservation for assisted procreation. In the last century, considering to perform a myomectomy in a 45-47 year old woman with myomas was an unlikely thought; nowadays, with the methods of assisted reproductive technique, many reproductive limits have been largely overcome, until the menopausal pregnancy. This clinical opinion is based on biologic anatomic morphological evidences, which allowed knowing better the consequences of uterine myomectomy within the capabilities of the uterus after myomectomy.