Cold Scissors and Small Myotomy: A Laparoscopic Intracapsular Myomectomy Method for Women in Reproductive Age.

Objectives: Authors evaluated the surgical outcomes of the "cold scissors" technique, focusing on minimal myotomy, during laparoscopic intracapsular myomectomies. The primary endpoints included the initial and final lengths of the uterine incision, as well as the duration of wound healing. Materials and Methods: The prospective observational cohort study was conducted from May 2017 to June 2022 on patients diagnosed with intramural fibroids (FIGO classifications 4-6), with fibroid sizes ranging from 4 to 10 cm in diameter. The mean initial uterine incision length was compared to that at the conclusion of the procedure, while the healing duration and factors related to the reduction of blood loss and postoperative recovery were also evaluated. Results: A total of 112 female participants were included in the study. The mean initial uterine incision measured 3.6 ± 0.6 cm, and by the conclusion of the procedure, it had reduced to 2.5 ± 0.4 cm. The average blood loss was 115 ± 22.3 mL. The healing period ranged from 30 to 50 days. Postoperatively, 45 clinical pregnancies were recorded, with 5 cases of miscarriage. No instances of uterine rupture were observed, and no adhesions were found in patients who underwent cesarean sections following the procedure. Conclusion: The laparoscopic approach utilizing "cold scissors" appears to be a reliable and feasible surgical option for intracapsular myomectomies, especially for women of reproductive age who may pursue postoperative conception. This technique is characterized by minimal incisions into the myometrium, leading to reduced myometrial injury, reduced bleeding, and a faster recovery period.