The "cons" of laparoscopic myomectomy in women who may reproduce in the future.

Several concerns must be addressed before LM will be accepted in place of laparotomy. Uterine healing and the extent of adhesion formation associated with laparotomy must be compared with those associated with the laparoscopic approach in which sutures are used. Women of childbearing age who require a myomectomy for an intramural fibroid should undergo either an abdominal myomectomy or a modified laparoscopic procedure to ensure proper closure of the myometrial defect. The laparoscopic approach is appropriate for pedunculated or subserosal fibroids when myometrial closure does not affect uterine bleeding.