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Surgical Management of Leiomyomas for Fertility or Uterine Preservation

Falcone, Tommaso, MD; Parker, William H., MD

doi: 10.1097/AOG.0b013e3182888478
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Leiomyomas are the most common pelvic tumors in women. These tumors are not always symptomatic but can cause abnormal uterine bleeding and anemia, pelvic pressure and pain, urinary frequency, and adverse reproductive outcomes—symptoms that can diminish the quality of life of women. Myomectomy is the primary treatment modality for women with symptomatic leiomyomas who are of reproductive age and desire future fertility. Myomectomy can significantly improve symptoms and quality of life and, in some clinical situations, improve reproductive outcomes. There are robust surgical outcome data supporting the use of a minimally invasive approach such as laparoscopy and hysteroscopy over laparotomy. Perioperative outcomes and return to normal activity are significantly better with a minimally invasive approach. Reproductive outcomes are not adversely affected. Detailed preoperative imaging is required for minimally invasive procedures to be successful. There are several evidence-based techniques that can be used to reduce blood loss during surgery. The role of robotic technology in enhancing surgical outcomes has not been clearly defined.

Myomectomy can improve quality of life significantly in women with symptomatic leiomyomas, and minimally invasive surgery can be performed successfully in most patients.

Department of Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio; and the Department of Obstetrics & Gynecology, University of California–Los Angeles School of Medicine, Santa Monica, California.

Corresponding author: Tommaso Falcone, MD, Professor and Chair, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk A81, Cleveland, OH 44195; e-mail:

Continuing medical education for this article is available at

Financial Disclosure Dr. Parker has received grants/research support from Ethicon Women's Health & Urology and has served as a consultant to Ethicon Women's Health & Urology. Dr. Falcone did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.