1. Dr.Maha Alhaji Dr.Ahmad Alkhaled

2. Laparoscopic myomectomy was described for the firsttime in 1979

3. Indications: Laparoscopic myomectomy is surgicalalternative for women with subserosal and intramural fibroids

4. The limits to laparoscopic myomectomy depend on a number of factors – the size(s), number and position of the fibroids, whether future fertility is desired, and the experience of the surgeon.

5. size of 8-10 cm total number of fibroids should not exceed four.

6. Complications: Uterine rupture Adhesion(35%) risk of miscarriage 41 to 19% risk of miscarriage 41 to 19% bladder, bowel, and ureteral injury, intraoperative and postoperative. Hemorrhage

7. postoperative hematoma (0.48%) bowel injury (0.04%) and emergency hysterectomy (0.09%).

8. Advantages: less analgesia shorter recovery time postoperative pain is less than abdominal myomectom short hospital Two days after surgery (15%) required analgesia by day 15: )90%) had fully recovered

9. GnRH agonist It is indicated for:

10. Effect of fibroid on pregnancy Infertility Abortion Increase rate of c-section Preterm labor Abruption placenta Abnormal position PPH(uterine atony)