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Expert Rev Endocrinol Metab. 2011 Sep;6(5):715-722. doi: 10.1586/eem.11.62.

Neurovascular bundle in fibroid pseudocapsule and its neuroendocrinologic implications.

Author information

1
a Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynaecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany.
2
b Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com.
3
c Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC 28203, USA.
4
d Department of Urology, Carolinas Medical Center, Charlotte, NC 28203, USA.
5
e Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
6
f Department of Obstetrics and Gynecology, German Medical Centre, DHCC, Dubai, United Arab Emirates.
7
g Unit of Cytogenetic and Molecular Genetics, Madonna delle Grazie Hospital, Matera, Italy.
8
h Department of Endocrinology, Vito Fazzi Hospital, Lecce, Italy.
9
i Department of Obstetrics and Gynaecology, SS. Annunziata Hospital, Chieti, Italy.
10
j Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy.

Abstract

The myoma pseudocapsule is a surgical-anatomical entity surrounding the fibroid that separates the myoma from normal uterine tissue. The myoma pseudocapsule has a delicate vascular network rich with neurotransmitters analogous to the neurovascular bundle surrounding the prostate. The pseudocapsule neurovascular bundle is extremely important during myomectomy to promote uterine myometrial healing and, consequently, for uterine reproductive function. New advancements in surgery, including the use of laparoscopic myomectomy by an intracapsular technique and magnification of the myoma pseudocapsule to enhance visualization are comparable to the dissection during a radical prostatectomy. Fibroid detachment occurring inside the pseudocapsule causes less bleeding, spares the neurovascular bundle and promotes better uterine healing. The maintenance of myometrial integrity after laparoscopic myomectomy maintains uterine function and therefore improves reproductive outcomes, including labor.

KEYWORDS:

fertility; laparoscopic myomectomy; leiomyoma; minimally invasive surgery; neurotransmitters; neurovascular bundle; pseudocapsule; reproduction; uterine fibroids

PMID:
30780878
DOI:
10.1586/eem.11.62

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