Fibroids or
myomas involve large proportion of women of reproductive age. The
myoma formation starts from the transformation of the myometrium, causing the progressive formation of a pseudocapsule, which is made of compressed muscle fibers. Numerous studies investigated on
myoma pseudocapsule anatomy, discovering many
neurotransmitters and
neuropeptides, as a neurovascular bundle, influencing myometrial physiology. These substances have a positive impact on wound healing and muscular restoring, also playing a role in sexual and reproductive function. Based on investigations, a distinct surgical technique evolved, called "intracapsular
myomectomy", meaning
myoma removal from its pseudocapsule, which enables protection of the
myoma pseudocapsule, containing
neuropeptides and neurofibers involved in physiological myometrial healing. This technique, performed by a gentle
myoma enucleating by stretching from myometrium and sparing pseudocapsule, reduces surgical
trauma caused by iatrogenic
myoma pseudocapsule damage. Intracapsular
myomectomy meets the basic surgical anatomy principle:
myoma is removed by a bloodless, precise and careful dissection sparing myometrium, as much as possible. The rationale of intracapsular
myomectomy should be applied to all
myoma removals; therefore, it has been used for both laparoscopic and laparotomic
myomectomy, as well as for cesarean
myomectomy. Scientific research is still seeks to clarify some reports of
myomas with
infertility, especially in the case of intramural
myomas, but it is clear that in the case of performing
myomectomy, it must do by the described intracapsular technique. This enables myometrial preservation, especially peripherally to
myoma bed, promoting myometrial healing after
myoma removal.