Hysterectomy pp 429-466 | Cite as

Uterine-Preserving Operative Therapy of Uterus Myomatosus

  • Andrea TinelliEmail author
  • Ospan A. Mynbaev
  • Daniele Vergara
  • Silvia Di Tommaso
  • Sandro Gerli
  • Alessandro Favilli
  • Ivan Mazzon
  • Radmila Sparic
  • Marina Eliseeva
  • Sergei S. Simakov
  • Alexander A. Danilov
  • Antonio Malvasi


Uterine myomas are the most frequent benign tumours of the uterus in women of childbearing age. Although uterine fibroids cause symptoms in only 20–50 % of cases, if present they may cause abnormal uterine bleeding, pain, and infertility.

The advent of modern endoscopy offers a valid minimally invasive alternative approach, avoiding radical treatment such as hysterectomy. Nevertheless, over the years complications due to the use of electricity during myomectomy have been highlighted. The concept of possible negative effects on fertility and pregnancy outcome due to the use of intraoperative monopolar or bipolar coagulation has been clearly demonstrated. Damage to the surrounding healthy myometrium after laparoscopic myomectomy is considered the major risk factor for uterine rupture in pregnancy. However, monopolar and bipolar coagulation are still widely used in clinical practice during myomectomy.

In the last decade numerous studies have been conducted on uterine myomas and new anatomical and physiopathological knowledge has come to light. Particular attention has been paid to the structure surrounding the myoma and its role on myometrial healing: the pseudocapsule. A neuro-biological property of myoma pseudocapsule was recently demonstrated as the vascular structure has specific characteristics similar to those of cancer.

For many years, surgeons have paid no attention to the presence of fibroid pseudocapsule during the myomectomy, probably due to underestimate of its functionality. The new knowledge on the myoma pseudocapsule confirms the importance of myometrial sparing during myomectomy and the advantages offered by the “cold surgery”.

These issues open new perspectives on treatment of uterine myomas and are of great mportance for fertility patients.


Laparoscopic Myomectomy Pseudocapsule (PC) Leiomyoma Uterine Fibroids Cold Loop 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Russian Science Foundation (grant 14-31-00,024). Some authors are members of the International Translational Medicine and Biomodeling Research Team (


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Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Andrea Tinelli
    • 1
    • 2
    Email author
  • Ospan A. Mynbaev
    • 3
  • Daniele Vergara
    • 4
  • Silvia Di Tommaso
    • 5
  • Sandro Gerli
    • 6
  • Alessandro Favilli
    • 6
  • Ivan Mazzon
    • 7
  • Radmila Sparic
    • 8
    • 9
  • Marina Eliseeva
    • 10
  • Sergei S. Simakov
    • 11
  • Alexander A. Danilov
    • 12
    • 13
  • Antonio Malvasi
    • 14
  1. 1.Department of Gynecology and Obstetrics, Division of Experimental Endoscopic SurgeryImaging, Minimally Invasive Therapy and Technology, Vito Fazzi HospitalLecceItaly
  2. 2.Laboratory of Human PhysiologyMoscow Institute of Physics and Technology (State university)DolgoprudnyRussia
  3. 3.The Department of Obstetrics, Gynecology and Reproductive MedicinePeoples’ Friendship University of RussiaMoscowRussia
  4. 4.Department of Biological and Environmental Sciences and TechnologiesUniversity of SalentoVia MonteroniItaly
  5. 5.Division of Medical Genetics, Department of Biomedical Sciences and Human OncologyUniversità “AldoMoro”BariItaly
  6. 6.Department of Obstetrics and GynecologyUniversity of PerugiaPerugiaItaly
  7. 7.Unit of Gynecology and Obstetrics“Arbor Vitae” Centre, Clinica Nuova Villa ClaudiaRomeItaly
  8. 8.Clinic of Gynecology and ObstetricsClinical Center of SerbiaBelgradeSerbia
  9. 9.School of Medicine, University of BelgradeBelgradeSerbia
  10. 10.Department of Obstetrics and GynecologyPeoples’ Friendship University of RussiaMoscowRussia
  11. 11.Department of Applied MathematicsInternational Translational Medicine and Biomodelling Research Group, Moscow Institute of Physics and Technology (MIPT)MoscowRussia
  12. 12.Institute of Numerical MathematicsRussian Academy of SciencesMoscowRussia
  13. 13.Moscow Institute of Physics and Technology (MIPT)MoscowRussia
  14. 14.Department of Gynecology and ObstetricsSanta Maria Hospital, GVM Care and ResearchBariItaly

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