Uterine fibroids are common benign
tumors in the female reproductive system. A
hysterectomy is the most effective treatment for symptomatic
fibroids. For patients desiring pregnancy, laparoscopic intracapsular
myomectomy (LM) is an alternative surgery option. Although LM is widely accepted to treat
fibroids, it is technically demanding with risk of excessive
bleeding and difficult suturing, especially in cases with large
fibroids or
tumors in unusual locations. Therefore, we developed an intracapsular rotary-cut procedure (IRCP) as a modification of laparoscopic intracapsular
myomectomy, with the intention to minimize risks of LM and help uterine healing. A summary of the improvements to the IRCP is described: 1) making an incision at the site of the
fibroid with a length of one-third to one-half of the
fibroid's diameter at a depth reaching the
fibroid's surface; 2) holding the
fibroid stably and making rotary cuts on the
fibroid at a depth of 0.5-1 cm within its pseudo-
capsule while pulling it outward slightly, making sure not to cut off any pieces of the
fibroid; and 3) repeating the cutting-and-pulling until the longest dimension of the
fibroid is outside the incision. The multiple cuts are to minimize the diameter and extend the length of the
fibroid. When the multiple cuts cause half of the
fibroid body to "shrink", the
fibroid is squeezed out by contraction of the surrounding myometrium. Evaluation of the outcomes of IRCP showed that the time of enucleation and suturing, intraoperative
bleeding, and decline of
hemoglobin were significantly lower in the IRCP group than the LM group. As for reproductive outcomes, the full-term live birth rate of the IRCP group was significantly higher than that of LM group. However, there was no difference in delivery modes between the two groups. In conclusion, IRCP significantly benefits fertility preservation by minimizing damage to the uterus, protecting myofibers of the pseudo-
capsule, and resulting in a shallower residual cavity, which eases stitching and causes less
bleeding. It is worthwhile to adopt IRCP in younger patients who desire preservation of their fertility.