**3. Myomectomy**

Uterine fibroids are the most common pelvic tumor, occurring in about 70% of women by age 45. However, many fibroids are small and asymptomatic. About 25% of white and 50% of black women have symptomatic fibroids. Fibroids are benign tumors of the muscle of the uterus most myomas do not cause clinical symptoms and do not require intervention. Based on location the various types of myoma are subserous, intramural and submucous fibroid. Most frequently, they develop in the myometrial wall and can lead to uterine distortion. Common problems associated with myomas are pelvic, abdominal, or back discomfort; urinary bladder irritability; abnormal uterine bleeding; bowel dysfunction; infertility; and pregnancy loss and/or complications. Myomas can cause infertility are mechanical interference with implantation, sperm and embryo transport, focal endometrial vascular and endocrine disturbances, endometrial inflammation, and abnormal uterine contractility. During the past few years, there have been a number of studies advancing the knowledge about the efficacy and safety of treatments of myomas, including medical and minimally invasive therapies. Laparoscopic myomectomy was first described by Semm and Metler in 1980 for subserosal fibroid there is an increasing trend for minimal access surgery for treatment of uterine myomas. Laparoscopic myomectomy is a very recent advance in the field of gynaecological surgery. Laparoscopic myomectomy has provided minimal invasive alternative to laparotomy with advantage of faster recovery and less postoperative adhesions. Laparoscopic myomectomy (LM) is an effective technique that is associated with the development of operative laparoscopic equipment and surgical techniques. The size does not matter for performance of a myomectomy laparoscopically. Laparoscopic myomectomy has evolved into a safe, efficient, and cost effective approach for the treatment of intramural, subserosal, and pedunculated fibroids. Criteria for myomectomy for surgical intervention, supported by the American College of Obstetricians and Gynecologists (ACOG) and American society for reproductive medicine (ASRM) are:


Before myomectomy, Hysteroscopy is performed in most patients at the outset of the procedure, than all pelvic structures and the abdominal cavity are inspected

Steps of operation: subserosal myomas

	- Injection with vasopressin.
	- Positioning of Roeder loop around the base of the myoma.

The Role of Endoscopy in Management of Infertility 11

age, depending on the population studied and the diagnostic criteria applied. The cause of PCOS is unknown. However, PCOS is thought to be a genetic disorder (autosomal dominant) meaning that each child has a 50% chance of inheriting the disorder from a parent who carries the gene. The gene can be inherited from either mother or father. The exact gene causing PCOS has not yet been identified. The condition was first described in 1935 by American gynecologists Irving F. Stein, Sr. and Michael L. Leventhal, from whom its

In 1990 a consensus workshop sponsored by the NIH/NICHD suggested that a patient has

In 2003 a consensus workshop sponsored by ESHRE/ASRM in Rotterdam indicated PCOS to

The insulin resistance with compensatory hyperinsulinemia is e prominent feature of the syndrome and seems to have a pathophysiologic role in the hyperanrogenism. It is a common hormonal disorder that is poorly understood and clinically characterized by lack of regular ovulation, irregular menstrual cycles, infertility, abnormal facial hair growth, obesity and polycystic ovaries. Polycystic ovarian syndrome can be difficult to diagnose because not all patients with PCOS display the same symptoms. Polycystic ovarian syndrome is a disorder characterized by insulin resistance and a compensatory elevated insulin level, which are found in both the overweight and non-overweight woman with the syndrome. In addition the patients has a risk for possible long-term metabolic hazards such as Type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease. The symptoms of PCOS and

original name of *Stein-Leventhal syndrome* is taken.

2. signs of androgen excess (clinical or biochemical)

3. polycystic ovaries (by gynecologic ultrasound)

their severity can vary from patient to patient;








3. other entities are excluded that would cause polycystic ovaries

PCOS if she has all of the following:

be present if any 2 out of 3 criteria are met

1. oligoovulation and/or anovulation

2. excess androgen activity

1. oligoovulation


Steps of operation: intramural and deep subserosal myomas

