Prior to the advent of modern minimally invasive surgery techniques, the primary surgical management of symptomatic leiomyomata for women desiring future fertility or uterine conservation was through laparotomy. Today, many cases of intramural and subserous leiomyomata are managed with laparoscopic myomectomy and selected cases of submucosal leiomyomata are managed with hysteroscopic myomectomy. The management of leiomyomata endoscopically is one of the more challenging procedures in minimally invasive surgery and requires a skilled surgeon. Despite its benefits, such as faster postoperative recovery and potentially less postoperative adhesions compared with laparotomy, many concerns still exist. Although pregnancy rates for women with leiomyomata managed endoscopically are similar to those after laparotomy, a major worry continues to be the risk of uterine rupture. The risk is essentially unknown. Lastly, the risk of recurrence seems higher after laparoscopic myomectomy compared with laparotomy.
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