Minimal invasive laparoscopic myomectomy with endometrial preservation and fertility enhancement

Objective: To evaluate the uterine scar and endometrial viability after laparoscopic myomectomy by two-dimensional (2D) ultrasound (US). To examine reproductive performance after surgery. Study Design: We performed a prospective, single-case, nonrandomized study in patients at the Dubai London Hospital: 107 patients with symptomatic fibroids who underwent laparoscopic myomectomy between January 2012 and May 2013. Methods: A total of 107 who underwent lap myomectomy were identified. An inclusion/exclusion criteria applied of which - 76 fulfilled the same. Their endometrial lining and uterine scar evaluated with the 2D US. Doppler study of the uterine artery and endometrial region performed alongside. The reproductive performance of these patients was then followed up over a 2 year period. Outcome: The endometrial sparing technique seems to be fertility sparing without the use of traction and minimal coagulation intraoperatively. The myometrial scar and endometrial lining can be followed up with 2D US, and the multiple suturing technique helps in improving scar integrity and ensures the absence of hematomas while preserving the endometrial thickness. The low resistance index (RI) of the ipsilateral uterine artery in a fibroid uterus shows an increase after surgery and goes back to normal between day 30-day 60. The subendometrial region had some increase but could not be quantified adequately due to lack of a method for the same. The RI of the uterine artery and the measurement of subendometrial color voxels still can be used as a measure of fertility prognosis and uterine receptivity after myomectomy. Limitations: This is a cohort investigation on a limited number of patients and does not compare the different number/size of myoma prior to removal in the US follow-up. Endometrial Doppler studies cannot be used as a prognostic tool of endometrial viability especially due to the lack of an accepted standard criteria to evaluate and measure the subendometrial perfusion.