Hormonal Treatment and Pelviscopic Myomectomy

In cases of benign lesions, pelviscopy is used in about 70% of all abdominal operations at our Department of Obstetrics and Gynecology. From 1990 to 1992, 851 patients with myomas were treated by surgery. In 57% pelviscopy, in 2% laparotomy, and in 1% hysteroscopic myomectomies were treated. In 11%, a CISH (Classical Intrafascial SEMM—serrated edged macro morcellator—Hysterectomy) without colpotomy was applied using the operative technique of pelviscopy or laparotomy. The application of this new surgical technique preserves the patient's pelvic floor (diaphragm pelvis and urogenitalis), its blood supply, and neural function. Details of the surgical techniques used in pelviscopic myomaenucleations are described. One hundred sixteen patients were treated with a gonadotropin releasing hormone analogue (GnRH-a) before the pelviscopic myomaenucleation took place. In this study, 64 (55%) patients received 3,75 mg leuprorelin, and 52 (45%), patients 3.75 mg triptorelin. The monthly injections took place over a period of 3 to 6 months. After 3 months, an identical reduction of the myomas of about 10% to 50% was observed in 103 patients (88%) in both therapy groups. The preservation of the uterus by this minimal invasive surgery technique was generally accepted. No serious complications occurred.