What are the steps of a laparotomy (abdominal surgical incision) myomectomy (surgical removal of uterine fibroids)?

From the Guidelines

Parotomy myomectomy is a surgical procedure to remove uterine fibroids through an abdominal incision, and it is indicated for subserosal or intramural fibroids, particularly in patients with multiple fibroids or very large uteri. The procedure begins with general anesthesia administration, followed by a horizontal or vertical abdominal incision depending on the size and location of fibroids, as outlined in the management of uterine fibroids 1. After accessing the uterus, the surgeon injects vasopressin around the fibroid to reduce bleeding. An incision is made on the uterine wall over the fibroid, and the fibroid is grasped with a tenaculum or myoma screw and carefully dissected from surrounding myometrium.

Key Steps

• Administration of general anesthesia
• Horizontal or vertical abdominal incision
• Injection of vasopressin around the fibroid
• Incision on the uterine wall over the fibroid
• Dissection of the fibroid from surrounding myometrium
• Repair of the uterine wall in multiple layers using delayed absorbable sutures
• Closure of the serosa with fine sutures for a watertight seal
• Closure of the abdominal wall in layers

The uterine wall is repaired in multiple layers using delayed absorbable sutures like Vicryl 0 or 1, ensuring hemostasis, as this approach allows direct visualization and removal of multiple or large fibroids while preserving the uterus for future fertility, though it carries risks of adhesion formation, blood loss, and longer recovery compared to minimally invasive techniques, as noted in the 2023 update on the management of uterine fibroids 1. The choice of parotomy myomectomy should be based on the individual patient's needs and circumstances, taking into account the potential benefits and risks, including the impact on fertility and quality of life.

From the Research

Steps of Parotomy Myomectomy

The steps of parotomy myomectomy, also known as abdominal myomectomy, involve a surgical procedure to remove uterine fibroids while preserving the uterus. The following steps are based on available evidence:

• Preparation: The patient is prepared for surgery, and a horizontal incision is made in the abdomen to access the uterus 2.
• Uterine incision: A incision is made in the uterus to access the fibroid, and the fibroid is carefully dissected and removed 2.
• Repair of the uterine incision: The uterine incision is repaired in layers to ensure proper healing and minimize the risk of complications 3.
• Closure: The abdominal incision is closed, and the patient is recovered from anesthesia 2.

Considerations for Parotomy Myomectomy

When considering parotomy myomectomy, the following factors should be taken into account:

• Size and location of the fibroid: Large fibroids or those located in difficult-to-reach areas may require a different surgical approach 4, 3.
• Patient's desire for fertility: Parotomy myomectomy can be a good option for women who wish to preserve their fertility potential 3, 2.
• Surgical expertise: The procedure requires a skilled surgeon with experience in abdominal myomectomy 4, 3.

Alternative Approaches

Alternative approaches to parotomy myomectomy include:

• Laparoscopic myomectomy: A minimally invasive procedure that uses a laparoscope to remove fibroids through small incisions in the abdomen 4, 5.
• Mini-laparotomy: A surgical approach that combines the benefits of laparoscopy and laparotomy, using a small incision to remove large fibroids 2.