ABSTRACT
Fibroids that are located intramurally are sometimes difficult to enucleate. After an incision is made through the myometrium with bipolar scissors, the enucleation of the myoma can be performed using bipolar forceps or bipolar scissors and a regular grasping forceps. In the case of bleeding, conventional plastic suction tubes from open surgery can be used to evacuate blood clots, and rinse out water and smoke. Additionally a forceps with a sponge can control the bleeding. After removing the fibroid, the myometrium must be sutured. In the case of intramural fibroids, adequate closure of the myometrium is necessary. In contrast to gas laparoscopy, conventional needle drivers can be used to manipulate suture material with a curved needle for adequate closure of the myometrial tissue. We perform closure of all layers with as few stitches as necessary to achieve an adequate and functional closure of the myometrial wound. With this technique, we avoid wound healing problems due to infections and necrosis that may occur with numerous stitches. Using this technique there is not much coagulation needed, which particularly causes necrosis and healing problems and, hypothetically, ruptures. More than 500 fibroid enucleations have been performed with the described technique and there have been no uterine ruptures during pregnancy or during delivery.
