Cesarean myomectomy technique: a critical review

Background: Cesarean myomectomy (CM) is, for many gynecologists, a discussed surgical procedure characterized by fibroid's removal during cesarean section (CS) followed by possible complications. For a long time, it has been common and shared thinking that myoma should not be surgically treated in pregnant women at the time of birth through CS in order to avoid complications for the patient. Nowadays, many studies reconsidered the feasibility of CM. The aim of this investigation is to summarize the scientific evidences on this procedure, highlighting when and how it can be performed safely. Methods: This review has realized basing on evidences reported in scientific database, as PubMed, Scopus, Cochrane Library, Medline and EMBASE databases, found using key words of reference to the main topic, the cesarean myomectomy. All the observational studies and meta-analysis published in the current century has been considered and results were critically evaluated by the authors, experts on CM. Results: According to the findings reported, the CM could be a valid and feasible treatment option for patients, especially when there are specific conditions which are associated with a lower risk of complications, as perioperative blood loss and risk of hysterectomy. Authors' experience and judgment agree with the evidences about the importance of the surgeons' skill and experience, both to make safer the surgical procedure and to have intraoperative and post-surgical outcomes. Conclusion: The applied surgical technique and the informative counselling and/or informed consent, still need standardization for a safer CM, both for the patients and for the operator, at the same time.