Uterine fibroids, also known as uterine leiomyomas or myomas, are benign tumors that develop in the muscular wall of the uterus. Made up of smooth muscle and connective tissue, fibroids are noncancerous growths that originate from the uterus. These tumors can range in size from microscopic to several centimeters in diameter. While many women do not experience symptoms, fibroids are the most common benign pelvic tumors in women. Common symptoms include heavy or painful periods, bleeding between periods, pelvic pressure or pain, frequent urination, difficulty emptying the bladder, and infertility or recurrent miscarriage.

Rise of Minimally Invasive Surgical Options

For many years, an abdominal hysterectomy was the standard treatment for symptomatic uterine fibroids. However, as laparoscopic and robotic techniques advanced, minimally invasive myomectomy emerged as a preferable option for many women seeking to preserve fertility or avoid the life changes of surgically induced menopause from hysterectomy. These minimally invasive myomectomy procedures utilize small incisions and advanced instrumentation to allow surgeons to remove fibroids through the abdominal wall instead of with a large abdominal incision. Advantages include less postoperative pain, shorter hospital stay and recovery time, and less scarring compared to traditional open procedures.

Global Adoption of Laparoscopic Myomectomy

Laparoscopic myomectomy first gained popularity in European countries in the early 1990s and has since been widely adopted globally. A 2017 study reviewing over 11,000 laparoscopic myomectomies performed worldwide found substantial increases in minimally invasive cases versus open procedures across countries studied, including a 50% increase in the US and over 300% increase in South Korea compared to previous years. International professional societies now recognize laparoscopic myomectomy as the standard of care for most women seeking to retain fertility. Robotic myomectomy is also gaining acceptance due to its magnified 3D visualization and improved ergonomics over traditional laparoscopy.

Surgical Techniques and Outcomes

Laparoscopic myomectomy requires advanced laparoscopic suturing skills to safely remove fibroids through small incisions and then reapproximate the uterine wall. Several different suturing methods have been described for closing the uterine defect, with single-layer interrupted sutures being most common. Compared to open myomectomy, studies show laparoscopic surgery reduces blood loss, shortens hospital stay, speeds return to normal activity, and lowers postoperative complication rates. A meta-analysis found the rate of minor or major complications with laparoscopic myomectomy to be 8.4%, including urinary tract injury, infection, and bleeding requiring transfusion. Fertility and pregnancy outcomes are equivalent to open surgery when performed by an experienced surgeon. Robotic assistance enables precision dissection and suturing which may further improve safety and outcomes.

Access and Training Considerations

While minimally invasive myomectomy reduces trauma compared to open surgery, it does require specialized equipment, operating room setup, and advanced laparoscopic skills. Lack of resources and training availability present access barriers in lower income regions of the world. Training programs have expanded rapidly but still cannot keep up with global demand. Sustainable initiatives are underway using telementoring and proctoring to transfer technical and surgical skills from international experts to local physicians. Simulation and augmented reality training also shows promise for widespread dissemination of minimally invasive techniques. Overcoming infrastructure and training barriers will be key to ensuring global access to state-of-the-art fibroid treatment options.