Minimally invasive techniques for
myomectomy are based on the rationale of preserving the myometrial integrity, in order to spare muscular and fibro-neurovascular myometrial fibers and ensure complete and bloodless
myoma removal. Post-operative myometrial vascularization is crucial in injured muscle regeneration. The post-surgical myometrial healing is needful for uterine reproductive function.
Neurotransmitters and neurofibers were analyzed in the
myoma pseudocapsule surrounding
fibroid. They activate signaling molecule synthesis and release which, in turn, promote cell activation and induce muscle regeneration and growth. Pseudocapsule damage during
myomectomy may lead to a reduction of
neuropeptides and neurofibers at the hysterotomic site, to a poor physiological myometrial healing, with more
fibrosis due to
hypoxia,
ischemia and
necrosis. These pathophysiological events cause deficit in myometrial neurotransmission, muscular impulse and contractility, with ultimately impaired uterine muscle function during pregnancy, labor and delivery. Hence, during
myomectomy, all manipulations should be performed as precisely and bloodlessly as possible, avoiding extensive, high wattage diathermocoagulation or excessive tissue manipulation or muscular
trauma. Any iatrogenic pseudocapsule damage may alter
neurotransmitter function during successive myometrial healing, impacting negatively on uterine repair and on eventual pregnancies. Hence the reasoned
myomectomy on a biological basis, the "intracapsular
myomectomy", satisfied these surgical and physiological requirements. It was described precisely and firstly by the hysteroscopy, with the image magnification of the preservation of the
myoma pseudocapsule. The "intracapsular hysteroscopic
myomectomy" demonstrated the safe and effective removal of submucous
myomas with intramural development. It allowed to completely remove the
myoma in one or two surgical steps, saving the pseudocapsule and the surrounding healthy myometrium. The respect of the myometrium and the reduced thermal injury, a part the excellent outcomes in terms of surgical complications prevention, post-surgical
fibrosis and
intrauterine synechiae reduction, highlighted the physiological development of a successive pregnancy, without any myometrial complications during pregnancy, labor and delivery.