# Management of 10 or More Uterine Fibroids by Laparoscopic Myomectomy: A Comprehensive Review

## TL;DR

This review discusses managing 10 or more uterine fibroids with laparoscopic myomectomy, focusing on techniques to reduce bleeding and improve patient outcomes.

## Contribution

The paper provides a structured overview of strategies for managing multiple fibroids through laparoscopic myomectomy, emphasizing patient safety and fertility outcomes.

## Key findings

- Perioperative bleeding-reduction strategies and advanced surgical techniques improve outcomes in laparoscopic myomectomy for multiple fibroids.
- Integration of medical pretreatment and standardized protocols enhances patient safety and resource utilization.
- Detailed preoperative counseling is essential to set realistic expectations for fertility outcomes.

## Abstract

Laparoscopic myomectomy (LM) for 10 or more fibroids combines the fertility-preserving benefits of minimally invasive surgery with the technical challenge of haemostasis and uterine reconstruction. This narrative review draws exclusively on randomized controlled trials (RCTs), systematic reviews, and meta-analyses to outline perioperative bleeding-reduction strategies, advanced surgical techniques, postoperative complications, and reproductive outcomes. This review highlights structured perioperative pathways with the integration of medical pretreatment, standardized intraoperative protocols, and postoperative care bundle with impact on resource utilization as well as overall patient outcomes. Multimodal preoperative optimization of individual patients involving pharmacotherapy, various collaborative intraoperative haemostasis techniques, precise stepwise surgical approach during LM, and vigilant postoperative management to identify as well as manage the postoperative complications improves overall patient safety. This review article focuses on detailed preoperative counselling to match realistic expectations of desirable fertility outcomes. The quality-of-life assessments and patient-reported outcome measures should be integrated into future research to capture the broader impact on reproductive health in these patients.