Running Suture for Laparoscopic Myomectomy

Reprinted with kind permission from TheTrocar.com

Introduction

Feasibility of laparoscopic myomectomy is now accepted even if the attention is still stressed on technical difficulties due to myoma location and size and difficulty in reapproximating the incision by laparoscopic suturing that requires perfect mastery of endoscopic suturing. The problem raises doubts about how solid is the uterine wall after laparoscopic myomectomy for patients desiring pregnancy. Uterine defective healing may in fact depend on lack in training or applying of a too superficial suture which can lead to formation of intramural haematomas, indentations and uterine fistulas.

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Moreover, suture affects the length of the entire procedure for about half the time.

We have calculated that for myomas 6-8 cm in diameter:

* 4-5 simple stitches are used
* 4-6 minutes are taken for applying each stitch and tying suture, plus 2-3 minutes for cutting the suture and inserting and removing the needle
* for a total of 30-50 minutes for suture.

Usually, suture is applied using interrupted, simple or more frequently cross-stitches tied intracorporeally using 1 or 0 Polyglactin sutures.

Possible single sutures:

• Suture in two layers
• Deep suture in one layer
• A deeper suture with a more superficial
  one including the first (Ideal suture)

Practical tip

Twenty patients underwent laparoscopic myomectomy for intramural myoma measuring 6 cm in larger diameter using a new technique: a running suture was applied firstly in the deeper plane starting from the apex of the myomectomy scar to the base, continuing along the more superficial plane from the base to the apex. The suture was in the end tied intracorporeally with the tail of the running suture.

Measurements and results

Conclusions

Reapproximation of the margins of the myomectomy scar using this new suturing technique seems to be sturdier and thorougher. On the other hand, the surgeon has to deal with a very long suture which can be cumbersome and disorienting in a narrow field. Moreover, a good teaming and coordination between surgeons is necessary because the assistant has to hold the running suture without being in the way of the operator having to cope in the meantime with the long suture.

References:

Related articles

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3. Dubuisson J-B, Chavet X, Chapron C, et al. Uterine rupture during pregnancy after laparoscopic myomectomy. Hum Reprod1995; 10:1475-1477. (Medline)

4. Dubuisson J-B, Chapron C, Chavet C, et al. Laparoscopic myomectomy: where do we stand? Gynecol Endosc1995; 2:171-173.

5. Dubuisson J-B and Chapron C. Uterine fibroids: place and modalities of laparoscopic treatment. Eur J Obstet Gynecol 1996 ; 65 :91-94. (Medline)

6. Hasson HM, Rotman C, Rana N, and al. Laparoscopic myomectomy. Obstet Gynecol 1992;80:884-888. (Medline)

7. Pasic R and Levine RL. Laparoscopic suturing and ligation. J Am Assoc Gynecol Laparosc 1995; 3: 67-79. (Medline)

8. Rossetti A, Sizzi O, Soranna L, et al. Fertility outcome: long-term results after laparoscopic myomectomy. Gynecol Endocrinol 2001; 15: 129-134. (Medline)